Why does the U.S. have the highest maternal death rate in the affluent world? This year, ProPublica and NPR have been investigating this question through our Lost Mothers series. We’ve explored myriad factors that contribute to the 700 to 900 American women who die each year from pregnancy or childbirth-related causes, as well as the more than 50,000 women annually who suffer life-threatening complications.

As we have continued to dig into this problem, we have focused on the personal stories of affected women and their families. Thousands of people have shared their experiences with us since our initial callout in February, and those stories hold critical lessons for hospitals, regulators and policymakers. Making such experiences visible and transparent — lifting them up not only as individual tragedies, but as part of a public health crisis that endangers all women — remains a vital aspect of this project.

In addition to this tremendous response from families who have lost someone, or narrowly escaped tragedy, we have received numerous emails from people who want to push the conversation further.

Your step-by-step guide to sparking community and change on maternal health.

We’ve heard from expectant mothers seeking more specific advice on finding the best possible provider and preparing for an emergency.

We’ve been contacted by advocates calling for a closer examination of where the health care system is failing women, including the areas of insurance companies and the responsibility of care providers.

We continue to hear from professionals, who are eager to highlight the vital roles of midwives, mental health care services and other providers. Essentially, our readers are looking to engage with this material beyond our stories, and yearning to exchange more of their ideas.

That’s why we’ve created the Lost Mothers Event Toolkit, a step-by-step guide designed to foster local conversation and connection around the U.S. maternal mortality crisis. Exploring these issues in your own community is a powerful tool to raise awareness, create opportunities to exchange perspectives and spark ideas for change.

We encourage interested organizations, health institutions and individuals to host discussions on the most important issues around maternal health in their communities. ProPublica’s toolkit makes it easy to plan a local event, with resources including:

Discussion Questions

We encourage you to communicate what’s most important to you around the issues. Feel free to use these discussion questions as a starting point for your community.

Videos you can show at your event

Printable handouts

Presentation slides and graphs

Suggested discussion questions

Customizable invitations and flyers

Sample social media posts

Ideas for locations and speakers

Event planning and promotion tips

Our team is also standing by to help you create a high-quality, high-impact event. Ask us any questions you have throughout the planning process at events@propublica.org.

In ProPublica and NPR’s reporting on maternal mortality in the U.S., our reporters identified a lack of awareness and transparency as a contributing factor to the problem. Taking these conversations from private to public, allowing people to connect with one another, is therefore an important aspect of the solution. We hope you’ll join us by bringing the discussion to your community.

More than half the 2,000 people who received pedestrian tickets in Duval County, Florida, from 2012 to 2016 saw their driver’s licenses suspended or their ability to obtain one limited, according to an analysis by the Florida Times-Union and ProPublica.

The tickets, which carry what can seem like a modest $65 fine, can have more significant consequences for those who get them and refuse to pay or are unable to do so.

Over five years, a total of 2,004 pedestrian tickets were issued in Duval County, which is comprised almost entirely by the city of Jacksonville. Of those tickets, 982 people who failed or were unable to pay the fine lost their driver’s licenses or their ability to obtain one, according to the analysis.

The license suspensions help answer a question at the center of a Times-Union/ProPublica investigation of pedestrian tickets in Jacksonville: What are the consequences for individuals swept up in the Jacksonville Sheriff Office’s aggressive enforcement of some two dozen often obscure pedestrian statutes?

Last month, the Times-Union/ProPublica investigation showed that 55 percent of the tickets given in recent years went to blacks despite the fact that they make up only 29 percent of the city’s population. Blacks were similarly overrepresented in the 932 tickets that led to license suspensions — 54 percent.

As of Tuesday’s City Council meeting, three elected officials on the body have called on Sheriff Mike Williams to order his officers to stop writing pedestrian tickets. Council member Garrett Dennis asked the Office of General Counsel to review what authority the council had to compel him to do so. In addition to voicing her support for that measure, council member Katrina Brown asked for a noticed meeting focused on pedestrian infrastructure and enforcement.

The Jacksonville Sheriff’s Office has insisted that blacks have not been targeted in the issuance of pedestrian tickets, and said it saw no reason to review the investigation’s findings of a disproportionate impact on African Americans. The office said those receiving tickets could contest them before a judge, and that it would address any erroneous or improper ticketing with additional training of officers.

Losing one’s license in a sprawling city like Jacksonville can make aspects of daily life seem near impossible, whether you’re a mother shuttling children to school or a trucker trying to secure your next job.

Eboni Dekine stands by where she received a jaywalking ticket near the intersection of Ricker Road and 103rd Street on Jacksonville’s Westside. ProPublica and the Times-Union determined the ticket was given in error, but Dekine’s driver’s license was suspended after she didn’t pay the fine.
(Dede Smith/Florida Times-Union)

Florida state Sen. Jeff Brandes, a Republican from Pinellas County who sits on the legislature’s criminal justice committee, has repeatedly introduced measures that would prohibit driver’s license suspensions for non-driving offenses.

In an interview Monday, Brandes said that a driver’s license suspension is often a Floridian’s first experience with the criminal justice system. Then, he added, it can “snowball” from there.

“You don’t pay the fine, or you can’t pay the fine, but you still have got to get to work — then you’re facing a Catch-22,” Brandes said. “Do I drive and not make it to work and get fired, or do I not drive and get fired? We just think that, unless it’s a driving-relating incident, you shouldn’t have to make that choice.”

The state senator’s bill, which he plans to submit for the third time, would allow for those who demonstrate financial hardship to perform community service if they are unable to pay civil fines. He said the bill has never made it to a full vote by the legislature. Clerks of court in Florida stand to lose about $40 million annually if the law governing driver’s license suspensions is modified.

“Unfortunately, the clerks of courts have been funded based on transaction volume, and one of their highest-margin transactions is driver’s licenses,” Brandes said.

The Times-Union and ProPublica identified the 932 suspensions by using data from the Duval County Clerk of Courts and the Florida Court Clerks and Comptrollers.

The tally is surely conservative. For instance, it does not include people who had their licenses suspended, but then reinstated after eventually paying the fine.

“Who would have thought that someone who gets a walking infraction is going to be barred from getting a driver’s license?” said Samuel Brooke, deputy legal director for the Southern Poverty Law Center’s Economic Justice Program. “I think it shows the absurdity of linking the ability to drive to the ability to fulfill a financial obligation in the criminal justice system.”

C.J. Brown wrote four times as many pedestrian tickets as any other officer in Jacksonville over the last five years. Most of them went to blacks. His boss says he’s just “good at his job.”

A truck driver, a mother, a lawyer and a number of young men offer their accounts of walking while black.

The Times-Union/ProPublica analysis also found that 68 juveniles between the ages of 12 and 17 had their chance of getting a driver’s license suspended — meaning any application for a license would require the ticketed youngster to pay off the fine.

“The idea of suspending the ability of someone in the future from getting a license when at the time they are a juvenile, they are a child, and they are being punished for a child activity, a child behavior, in a way that is really severe,” said Brooke of the SPLC. “This isn’t go spend an hour in the principal’s office. This is you won’t be able to drive, you won’t be able to drive until you come up with a way to pay off this fine, and that’s just frankly unconscionable.”

State Rep. Tracie Davis, a Jacksonville Democrat, said that she, too, would be looking into ways to change the laws governing pedestrian citations and driver’s license suspensions.

Davis added that people might not grasp the seriousness of the ticket, which then gets left unpaid, and leads to the suspensions.

“It’s just extreme,” Davis said, “and it has extreme after-effects for people of color.”

What’s more, 132 of the tickets, issued for crossing outside of a crosswalk, led to license suspensions, but didn’t conform with state law and should never have been issued, according to the analysis. The infraction applies only when people cross in between intersections with traffic lights, but was routinely cited without regard for traffic light placement.

The sheriff’s office has previously said it has asked the local state attorney to give it guidance on the proper application of the crosswalk statute.

Are you interested in helping revitalize local reporting and reinventing journalism along the way?

Then apply to be the engagement reporting fellow for ProPublica’s Local Reporting Network.

The network is an initiative we recently announced to support local journalism. We’re going to be covering the salaries of, and providing editorial support for, reporters to do investigative journalism at seven news organizations across the country next year. Here are the organizations and reporters we’re going to be working with.

In addition to hiring a senior editor to oversee see the initiative, we are hiring an engagement reporting fellow to help develop and execute ideas that give communities the opportunity to contribute to or participate in the work.

You’ll work closely with the local reporters and their news organizations, as well as the senior editor and ProPublica’s award-winning engagement team. Some of our partner newsrooms are bigger than the others; in some instances, you might be in a more advising or consulting position. In others, you might be leading and managing the engagement portion of the project.

You’ll be involved from the very beginning of our work in the project, thinking about how to find and reach the communities we need in order to tell the story, pull them into the work to help inform the story, and find ways to maximize the resonance of the project after publication.

So what exactly are we talking about? Take a look at a project we’ve done about Vietnam vets exposed to Agent Orange. Unlike traditional investigations, we didn’t start with a story. We announced that we were doing an investigation with a callout to the community. We asked vets to tell us their stories, and we’ve now heard from nearly 8,000 of them. This community has fueled our reporting, and it’s gotten results.

This isn’t a traditional social media job, but social media is very much part of the job. You’ll need to understand not just social media but how news organizations can use it to tell stories. Here is a tweetstorm we did on refugee vetting. Here’s a story we decided to do exclusively on social about a lobbyist now working at a federal agency he lobbied.

Is all of this the kind of work you want to do? Yeah? Cool. We are looking for someone early in their career who has some of the following skills (or interest in building out them out):

Experience organizing communities and audiences, especially in a journalistic context. This can have been done digitally (think Facebook groups or web forms) or in real life (events and forums).

Ability to spin many plates. You’ll be working with a number of reporters across the country on different projects, potentially dealing with several different editors. You’ll need to stay organized, focused and proactive.

A good listener — this includes on social media and all around the web. We want to understand what the conversation might be around a particular topic — and then turn that insight into actionable items. Like this.

Above all, we’re looking for somebody who is excited about helping us build this initiative and make hard-hitting, great investigative journalism resonate in these communities.

We know there are great candidates who won’t fit everything we’ve described above, or who have important skills we haven’t thought of. If that’s you, don’t hesitate to apply and tell us about yourself.

We are dedicated to improving our newsroom, in part by better reflecting the people we cover. We are committed to diversity and building an inclusive environment for people of all backgrounds and ages. We especially encourage members of underrepresented communities to apply, including women, people of color, LGBTQ people and people with disabilities.

President Donald Trump’s choice to head a federal coal mine regulator, like more than one of his nominees, is a vocal critic of the very agency he’s being asked to lead. Steven Gardner is a longtime coal industry consultant, and he has called the agency’s marquee Obama-era regulation the product of “one of the most disingenuous and dishonest efforts put forward by a government agency.”

But in Gardner’s case, there is an unusual — and contentious — twist: He runs an engineering firm that produced a report as part of the process of preparing that regulation, and the agency deemed it so shoddy that it cut ties with Gardner’s company. Now he’s the nominee to head that agency, the Office of Surface Mining Reclamation and Enforcement. (In broad terms, OSMRE — pronounced “oz-muhr” — focuses on mining’s effect on the environment, while the other key regulator, the Mine Safety and Health Administration, focuses on the welfare of miners.)

State and federal officials at the time harshly criticized a draft report produced jointly by Gardner’s firm, ESCI, and other contractors. They blasted it as “nonsensical,” “junk,” “inaccurate and incomplete,” and “a piece of crap.” Some OSMRE staff members went so far as to accuse Gardner of trying to sabotage the regulation his firm was hired to help develop.

Acrimony and accusations flowed in both directions. Gardner charged that agency officials had pressured contractors to soften the projected economic impact of the regulation, the Stream Protection Rule. The stated purpose of the rule was to limit damage done by coal mining to waterways, but Gardner and other critics saw it as a strike at the heart of the coal industry.

Gardner is expected to testify in the coming weeks at a confirmation hearing before the Senate Committee on Energy and Natural Resources. Former Obama administration officials and a contractor who worked with Gardner have questioned how he will lead an agency that he has held — and that has held him — in something less than high regard.

“It has been said that one of my biggest challenges will be winning the support of OSM staff I will oversee due to the past controversies,” Gardner said in an emailed statement. “While there may be some in OSM that differed with my opinions, many others sent me messages of support noting they did not agree with OSM management during that controversial period.” (The White House referred a request for comment to the Department of the Interior, OSMRE’s parent agency, which did not respond to a request for comment.)

This was no backroom tiff. The conflict between Gardner and OSMRE played out in unusually public forums, including congressional hearings. On Capitol Hill, Republican opponents of the Obama administration’s ambitious environmental and energy agendas had branded its coal policy a “war on coal.” They seized on Gardner’s claims as evidence that the administration was fighting dirty.

Gardner’s strained relationship with the agency can be traced to 2010. ECSI was among a group of contractors hired to analyze the environmental and economic impact of various proposals for the Stream Protection Rule. OSMRE officials hoped ECSI and another subcontractor, Morgan Worldwide, would serve as counterweights to each other. ECSI worked principally with the coal industry, while Morgan Worldwide tended to represent environmental interests.

By the fall of that year, state and federal officials had begun to express doubts about whether the contractors were up to the task. “If this had come from one of my entry-level students (when I taught college hydro), I would have failed them,” OSMRE scientist Debbie Dale wrote in an email that November, describing a section of the draft report assigned to ECSI. She called it the “most poorly written ‘professional’ document” she had ever seen, according to the 2013 inspector general report. Eight state regulators wrote a letter to OSMRE Director Joseph Pizarchik, calling it “often nonsensical and difficult to follow.”

At one 2011 meeting, Dianne Shawley, a senior agency attorney, laid the bulk of the blame at the feet of ECSI and the other subcontractors. “They’ve given you a piece of crap, really. To be blunt,” she told executives from the general contractor, Polu Kai Services.

Agency officials were dismayed. “In my experience, it was very unusual to receive so much negative feedback about a contractor’s work,” said Pizarchik, who stepped down at the end of the Obama administration, in an interview with ProPublica. “I’m not aware of other instances where this has occurred.”

Sean Jensen, the president of Polu Kai Services, defended the draft report, noting the contractors never had a chance to finish it. “We did our job,” he said. “I’m happy with the team’s work.”

In the meantime, another concern had surfaced, this one limited to Gardner. Staff members, who have since left OSMRE, told Pizarchik they believed Gardner was trying to undermine the Stream Protection Rule. They accused him of being uncooperative, asserting that he was deliberately misreading parts of the draft rule so he could condemn it as an overly broad ban on underground mining. (In an email, Gardner described himself as cooperative and his reading of the rule as correct.)

Gardner had spent decades consulting for coal companies and would later be elected president of a major professional association for the mining industry. A Kentucky native, he is fond of observing that, because he grew up on a tobacco farm, he has “the honor of being involved in the two most politically incorrect industries in the country.”

The dispute between the contractors and the agency came to a head in January 2011. The Associated Press had published a leaked draft of the contractors’ initial analysis. It suggested that the Stream Protection Rule would have a devastating impact, wiping out 7,000 mining jobs nationwide.

OSMRE officials disputed the accuracy of the projection, but by then it was too late. The job-loss figure had become a part of the public discourse around the agency’s incipient rule.

The fallout from the leak prompted a series of at times heated meetings at which OSMRE officials and the contractors tried to resolve their differences. The endeavor proved unsuccessful, and in March 2011, agency officials declined to renew the contract. They hired a new set of contractors to complete the project, though they retained Morgan Worldwide. (John Morgan, president of Morgan Worldwide, said agency officials never complained about his company’s work.)

Congress, however, wouldn’t let the issue rest. Republicans had found in the dramatic job-loss figure powerful ammunition for their fight against the Obama administration’s coal policy. “It was all about blocking everything the Obama administration wanted to do,” Pizarchik said. “Everything was a war on coal.”

At congressional hearings in November 2011, the tensions between OSMRE and the contractors spilled into the open. When one congressman declared that the Stream Protection Rule “will kill jobs and stop coal mining,” Pizarchik accused the contractors of producing job-loss projections with “no basis in fact.” Incensed, Gardner testified two weeks later that OSMRE officials had put pressure on the contractors to manipulate their analysis to obscure the reality that the rule would decimate the American coal industry.

The dispute attracted the attention of the inspector general for the Department of the Interior, which ultimately produced a report that criticized both sides. The IG concluded that OSMRE officials had managed the contracting process poorly, but found no evidence to support Gardner’s claim that administration officials had tried to improperly influence the contractors’ work. The contractors’ job-loss figures, investigators concluded in their 2013 report, weren’t fabricated, but they relied on little more than claims of expertise.

“The contractor and subcontractor could not identify any of the assumptions they made,” Pizarchik said. “Staff reported to me they said, ‘We’re the experts. That’s our opinion. Rely on that.’ ... It was purely their opinion derived through the ‘expert elicitation process.’” (Gardner disputed this, saying the assumptions “were clearly identified.”)

All these years later, Gardner has come out on top in one respect. In February, less than a month after the Stream Protection Rule went into effect, Congress nullified it. In the intervening years, Gardner had continued to denounce OSMRE and the Stream Protection Rule in lectures, on his Facebook page and in newspaper op-eds.

It remains to be seen whether the victory proves Pyrrhic. “I think it’s a fatal flaw,” John Morgan, Gardner’s fellow subcontractor, said. “If you abused civil servants and accused them of the types of actions he did, it would be very difficult to be a leader.”

Vignesh Ramachandran, who came to ProPublica Illinois from the Stanford Computational Journalism Lab and Bay Area local news startup Peninsula Press, is in charge of making sure the look, feel and design of ProPublica Illinois’ content makes sense to readers. He strives for an almost invisible design that allows people to focus on the stories. In the 10th of a series of Q&As with ProPublica Illinois staffers, Ramachandran chatted with ProPublica Emerging Reporter Andrea Salcedo.

What inspired you to become a journalist and eventually a digital producer?

Storytelling was something that, even as a kid, I was always drawn to. When I was little, my parents would read stories to me every night. I started becoming a voracious reader and was always interested in this idea of stories. Journalism seemed to be this interesting intersection of storytelling, current events, history and the future, which is something I’m innately interested in. I was a kid reporter for The Denver Post’s kids section, which is my hometown paper. I really loved this idea that you could go interview someone and have the license to just ask them questions. I was also a fan of Radio Disney at the time, and we got to do segments on air. That really got me excited. I thought, “Hey, maybe journalism is something I’d want to do.” I was on my high school newspaper staff and ended up pursuing journalism in college. It’s been an element that has always been a part of me.

How would you explain to readers your job as a digital producer?

Basically, I help get our stories on the internet. That involves producing the story in our content management system and making sure we have multimedia assets, whether that’s art, prepping video embeds, things like that. Making sure the look, feel and design is something that will make sense for the reader. It’s working with the reporters and editors in Illinois and also coordinating with the design and production team in New York.

What has been your most rewarding experience as a journalist and digital producer?

The most rewarding experience is seeing stories that either I helped produce or I reported reach audiences. In my last job, I worked on a long-term investigation focused on police interactions with the public. We collected traffic stops data from around the country, and one of the most exciting parts for me was not necessarily the stories that our group did about possible racial bias, but the fact that we were able to clean and give that data to local newsrooms around the country. Then seeing those newsrooms reporting on how policing affects their community. I was excited to just see how you can break off a piece of a reporting project and help fellow local journalists around the country.

What are you excited about producing with ProPublica Illinois?

One thing that really excites me about web producing here is we’re really thinking about the reader. My interest in investigative journalism is why I wanted to come to ProPublica Illinois. I’m excited about the reporting that happens here, but also by this question: How do you make sure that really important reporting is being seen by audiences, having impact and also is in a form that makes sense? Right now, we’re producing for the web, but I’m interested in how might you translate an especially interesting investigation for when someone’s commuting by bus to their job, driving in the car or getting ready for work at home. How might we best serve readers on a single story beyond just our website?

What are some underreported stories in Illinois that you wish had more coverage?

I would say environmental topics. There’s a lot of opportunity for investigating both how the private sector and public sector interact when it comes to environmental policy and compliance with laws that protect our environment. That’s something to explore here in Chicago, but also all across the state. I’m interested in meeting people living here to better understand that.

How do you hope the stories that you help produce at ProPublica Illinois will spark change?

As a producer, I want to make sure we can create story packages where the design is almost invisible in a way, that it’s beautiful and the reader enjoys it, but it’s not ever in the way. It lets people focus on the stories because that’s ultimately what it’s about, whether someone is reading something on their phone or on their computer.

What storytelling and/or web production techniques would you like to experiment with at ProPublica Illinois?

I’m interested in exploring how we can deliver a story in the best way. How do you deliver one investigation in the way someone wants to consume it and based on the context they're in? And how are we putting together a story package in a way that someone from Chicago will be interested in and want to consume but also someone in Carbondale in southern Illinois. I’m also interested in starting to think about what devices or tools might everyday people be using in five, 10, 20 years. Are people actually going to be using smart speakers? Is it a fad now or would we all want to eat our waffles in the morning and listen to Alexa read us the news? If, 20 years from now, driverless cars are a mainstream thing and you don’t have to be at the wheel, how might a news story be presented there? Is it just going to be a TV news story or are there new ways to think about that? I’m really interested in the future.

What has been the biggest lesson journalism has taught you?

I know it’s cliché to say, but everyone has a story. I found early in my reporting career that some of the most interesting stories came from the most unexpected moments, whether that was having coffee with someone or sitting through a two-hour city council meeting. Oftentimes, some of the most interesting characters, stories or sources would come out of that. It’s being aware and listening at all moments and just being receptive. It often happens organically if you’re listening.

More than 30 years ago, Congress identified what it said was a grave threat to the American promise of equal justice for all: Federal judges were giving wildly different punishments to defendants who had committed the same crimes.

The worries were many. Some lawmakers feared lenient judges were giving criminals too little time in prison. Others suspected African-American defendants were being unfairly sentenced to steeper prison terms than white defendants.

In 1984, Congress created the U.S. Sentencing Commission with remarkable bipartisan support. The commission would set firm punishment rules, called “guidelines,” for every offense. The measure, signed by President Ronald Reagan, largely stripped federal judges of their sentencing powers; they were now to use a chart to decide penalties for each conviction, with few exceptions.

Five years later, a legal challenge to the sentencing commission wound up before the U.S. Supreme Court. In a case titled Mistretta v. U.S., the court was asked to consider whether Congress had overreached by taking on what seemed to be a role for the judiciary. In an 8-1 decision, the justices determined that the sentencing commission was constitutional. And they took care to say that the commission was also needed — to end the widespread and “shameful” sentencing disparities produced by the biases of individual judges.

Mistretta was a momentous decision, but it’s now clear the high court relied on evidence that was flimsy and even flat-out wrong.

The justices, in issuing the 1989 decision, had cited a single congressional report in concluding that there were disturbing and unacceptable sentencing disparities that needed to be addressed. That single report, in turn, was based primarily on two studies conducted in the early 1970s, both deeply flawed.

One of the studies was an experiment that surveyed federal judges about sentences they might give in hypothetical cases. Asked what sentences they would give in a specific tax fraud case, for example, the prison terms recommended by the judges ranged from three to 20 years.

That sounds significant. But the experiment ignored a basic fact about the real-life workings of the federal courts: Judges acted as the sole arbiter of sentences in a tiny fraction of cases. The vast majority of sentences were the result of plea bargains negotiated by prosecutors and defense lawyers, deals that were subject to a judge’s approval but that were not his or her handiwork. If fact, there was no evidence offered that judges around the country were signing off on vastly different plea bargain terms. And later research would debunk the claim.

The other study compared average sentences in federal district courts and indicated prison terms for identical crimes were often years longer or shorter depending on where judges presided. But an examination by ProPublica shows that the study was riddled with sample size errors that should have rendered much of the data unusable.

For example, the study said the average prison term for larceny in federal courts nationwide was three years and four months. In Maine, the average was listed as 12 years, more than three times as harsh. But our examination of the underlying data shows that only one person was sentenced to prison for larceny in Maine’s lone federal court that year; the “average” used by the congressional study was based on a single conviction.

The study — done for a Senate committee working on sentencing reform and using data from the Administrative Office of the U.S. Courts — was also distorted by an outright mistake. The study claimed Kentucky’s eastern district court sentenced burglary convicts to, on average, nearly 14 years in prison in 1972, which appears remarkably punitive for a property crime and out of whack with courts in the rest of the country. The study’s data, not the judges, was the problem, it turns out.

ProPublica’s review shows Kentucky’s eastern district had only four prison sentences for burglary that year. Three of the convicts were adults who received an average prison term of three years and four months. The fourth case involved a juvenile defendant supposedly sentenced to 550 months — more than 45 years — in a cell. The maximum sentence for burglary was 15 years, making that an impossibility, but the mistake wound up in the report that helped shape the thinking of the nation’s highest court. Court officials in Kentucky told ProPublica they could not determine what the juvenile’s sentence had actually been.

In recent months, ProPublica has fact-checked a sampling of the Supreme Court’s majority opinions from 2011 through 2015, and found a number of errors or glaring inaccuracies. The errors came from legal filings, from government records and from the independent research by the justices themselves.

In the case of the sentencing commission, the court’s decision proved enormously consequential. The federal sentencing guidelines produced by the commission helped remake the nation’s prisons. During the following decade, far more people went to prisons to serve far longer sentences.

“The guidelines did increase severity, pretty much across the board,” said Kate Stith, a Yale University law professor and expert on the federal sentencing commission.

Individual states followed the federal lead and instituted sentencing guidelines for state offenses, similarly lengthening prison terms and inflating prison populations.

Yet ample scholarship done over 30 years has only made clearer that the central rationale for the commission’s creation — large and pervasive discrepancies in sentencing imposed by judges — never existed.

Multiple sophisticated analyses of court data have found that judges, when left to deliver sentences on their own, do not differ greatly. Before the guidelines took effect, the average difference between judges was roughly five to eight months — not years, as the congressional report claimed and the nation’s highest court believed. After the guidelines were instituted, additional analysis has shown, the difference between sentences shrank by roughly a month.

Today, the sentencing commission’s guidelines are merely “advisory,” not mandatory, as a result of several subsequent Supreme Court decisions involving whether aspects of the guidelines violated a defendant’s right to trial. Today, judges can largely disregard the rules so long as they explain their reasoning.

The purported sentencing disparities that spurred the guidelines in the first place were not considered in the later rulings that restored federal judges’ discretion.

ProPublica requested comment from Chief Justice John Roberts and the other justices. As they had when presented with the earlier errors in opinions uncovered by ProPublica, the justices declined to respond.

To a significant degree, the drive for sentencing reform started with Marvin Frankel, a veteran federal judge in New York in the early 1970s. Frankel believed he and his colleagues were too easily swayed by biases and passions — in short, judges were too human — to be trusted with handing out criminal penalties on their own. Frankel’s book, “Criminal Sentences: Law Without Order,” published in 1973, became a rallying-cry for a movement.

“The almost wholly unchecked and sweeping powers we give to judges in the fashioning of sentences are terrifying and intolerable for a society that professes devotion to the rule of law,” Frankel wrote. The federal courts lacked strict rules for the appropriate punishment for each crime and individual judges reached wildly different sentences in similar cases, he argued. “The result is chaos.”

Stith, the Yale professor and expert on the sentencing commission, said Frankel’s argument found an eager audience. Republicans and Democrats, she said, had for years been promoting their own narratives — of the too-punitive “hanging judge” or the too-lenient “bleeding heart judge” — to suit their agendas.

Frankel wasn’t done after his book was published. He next helped to oversee an experiment that further fed such narratives. The Second Circuit U.S. Court of Appeals — which includes New York, Connecticut and Vermont — sent 20 hypothetical criminal case files to its judges and asked them to choose sentences. The files described an array of convictions, including many white-collar and illegal drug trade crimes.

Ilene Nagel, then a law and sociology professor at Indiana University, said the conclusion to be drawn from the experiment was clear: Judges produced unacceptably divergent sentences.

“It wasn’t a contested issue,” said Nagel, who was one of the first appointees to the sentencing commission.

The calls for reform were bipartisan to a degree unthinkable today.

The resulting legislation proved sweeping. It eliminated the federal parole system and formed a sentencing commission. The new agency would have seven members appointed to six-year terms by the president and then confirmed by the Senate. The commissioners would include judges, academics, prosecutors and defense lawyers. They’d write sentencing guidelines based on the criminal offenses, the defendants’ criminal histories and other factors related to the seriousness of the crime. Their word was binding.

Sen. Strom Thurmond, the longtime Republican leader from South Carolina, introduced the bill, which included the sentencing overhaul among several changes in the criminal justice system. Sens. Edward Kennedy and Joe Biden, pillars of the Democratic party, were among the bill’s earliest co-sponsors. Only one senator voted against the measure when it went to the floor in 1984. The House of Representatives passed it easily, with almost 100 “yes” votes to spare.

The Second Circuit survey went all but unquestioned for nearly 20 years, until researchers began examining the sentencing guidelines’ effect and gave Frankel’s arguments fresh scrutiny. Most notably, a U.S. Department of Justice study into racial disparities in sentencing in 1993 served as a takedown on the long-heralded experiment.

“Defendants in many courts plead guilty only after various kinds of agreements are reached regarding charges, sentence recommendations, and even ‘sentence promises,’” the Justice Department report stated, evaluating the Second Circuit results.

In real court cases, “it is likely that these dynamics constrained judges in their sentencing decisions,” the Justice Department report added.

Federal judges were not, in general, sentencing erratically, said Douglas McDonald, an expert in health and criminal justice analysis at the global research firm Abt Associates. That became clear “when you looked at real data,” McDonald said, “not the made-up, simulated thing that Judge Frankel sent around.”

The second study the Supreme Court relied on in Mistretta doesn’t fare well under scrutiny, either.

It looked at sentencing data from actual federal criminal cases. A consultant to the Senate’s Judiciary Committee, which was drafting the sentencing reform legislation in the late 1970s, and a pair of legal scholars from Yale and the University of Texas compiled the numbers from the federal courts system.

The effort was intended to further prove that sentencing was chaotic, varying greatly by judge and just as significantly by region. The data compared average sentences for certain crime categories between individual district courts to averages for the rest of the country. The authors set out the numbers in easy-to-digest charts, which gave the stark impression that geography dictated the degrees of punishment.

However, the California district’s “average” was not an average at all. Only one burglary convict was sentenced to prison there during that year, data from the study’s appendix shows.

That problem with sample size was just one of many in the study, which ProPublica scrutinized as part of its reporting on misinformation in the Supreme Court’s majority opinions. ProPublica was fact-checking a 2013 ruling, Peugh v. U.S., that relied on information from the Mistretta opinion about the sentencing commission.

ProPublica unearthed hundreds of pages containing four-decades-old federal courts data to test the sentencing averages study. It appears to be the first time the research has been rigorously checked.

The study’s first criminal category — homicide and assault — is so riddled with sample size flaws its figures are useless. Averages for the Maryland and New Jersey judges are based on two cases in each case. (State courts generally handle violent crimes so it makes sense that federal courts did not hand out many such sentences.)

While the Supreme Court's Mistretta opinion and lawmakers repeatedly said that judges’ sentencing disparities could not be explained by defendants’ criminal histories, the analyses of federal data they depended on did not address the question.

For instance, the congressional report singled out the Illinois northern district court as unjustifiably lenient on robbery convicts; it averaged prison terms of less than seven years in 1972 compared to the national average of 10 years.

But it turns out robbery convicts in the Illinois court were a lot different than those across the country. A majority had no criminal history at all, and only 28 percent had previously served time in prison. The shorter sentences, then, were easier to understand.

Further illustrating the point, judges in the Missouri eastern district averaged 15-year prison sentences for robbery, several years longer than the national average. But 85 percent of that court’s convicts had been in prison before. The underlying data suggests that defendants with bad criminal histories often received longer prison sentences.

The sentencing guidelines took effect in November 1987. One month later, John Mistretta was indicted on drug trafficking charges in Missouri, for which he pleaded guilty to a single count of conspiracy to distribute cocaine and received 18 months in prison under the new rules. He appealed his punishment, arguing that the commission and its work violated the separation of powers required in the Constitution.

Lawyers for the federal government defending the guidelines provided the congressional report, containing the judge experiment and district sentencing averages, to the Supreme Court. The case centered on legal arguments, not questions about the statistical evidence.

Rather, the justices and lawyers treated the crisis of sentencing judges as established fact. “Congress wanted to fetter the power that individual judges had been exercising, because they are the ones who created the problem,” Justice Anthony Kennedy said during oral arguments in Mistretta. “They are the ones who gave the disparate sentences all around the country.”

Paul Bator, who represented the sentencing commission, described federal judges’ control of criminal punishment as being “very ugly days of discriminatory and arbitrary sentencing.”

In the majority opinion, Justice Harry Blackmun referred to sentencing disparities among judges as “a serious impediment to an evenhanded and effective operation of the criminal justice system.”

The consequences of the court’s ruling were considerable and have helped fuel sharp debates about issues such as mass incarceration.

In 1984, the average prison term handed down by federal courts was two years. That more than doubled over the decade that followed, according to figures from the sentencing commission. About half of federal convicts received probation when judges controlled most of the sentencing. Only 7 percent got probation last year.

Stith, the Yale professor, said the sentencing commission’s guidelines came to include sentencing “enhancements,” such as whether a defendant attempted to destroy evidence or had access to a weapon. They became a major part of the new punishment formula and had the effect of lengthening sentences.

Those “enhancements” eventually became the focus of another case that wound up before the Supreme Court. Lawyers for defendants argued that the sentencing enhancements were akin to convictions for additional crimes, crimes that had not been proven as part of the criminal prosecutions. The Supreme Court eventually barred the use of the enhanced penalties.

Read More

A ProPublica review adds fuel to a longstanding worry about the nation’s highest court: The justices can botch the truth, sometimes in cases of great import.

But the creation and legal endorsement of the commission preceded a variety of developments that led to harsher penalties in court. Congress, for instance, made the punishment for crack cocaine 100 times more severe than for powder cocaine. In 1985, the federal prison population consisted of just over 40,000 inmates, according to U.S. Bureau of Prisons data. During the decade that followed, with fixed prison sentences and tough anti-drug laws, the prison rolls grew by 150 percent and topped 100,000 inmates in 1995.

Nagel, the former commissioner and law professor, said the anti-drug laws are to blame for most of the severe penalties that swelled the federal prison population. Commissioners tried to prevent, or at least minimize, the harshest sentencing changes, she said.

“On several occasions, the commission tried to get Congress to back away,” Nagel said. She and her colleagues argued to lawmakers that violent crimes should be the priority for long sentences, not drugs. Their lobbying failed.

Drug prosecutions, in the end, produced their own set of disparities — disproportionate numbers of minority defendants. In 1996, 73 percent of those convicted for drug trafficking were black or Hispanic, roughly triple their share of the nation’s population. Researchers had struggled for decades to demonstrate racial disparities in federal sentencing. Suddenly, the gaps were glaring and repeatedly proven.

Indeed, sentencing disparities by race remain prevalent as ever, according to an analysis the commission released last month. Black men’s prison terms the past two years were 19 percent longer, on average, than those received by white men, the study shows. The difference cannot be explained by the crimes or the defendants’ criminal histories. The sentencing commission says there is no sign the racial gap for incarceration is getting smaller.

We are looking for a reporting fellow to join our Documenting Hate team, which chronicles and investigates hate crimes and bias incidents in America — where they happen and to whom; how they are prosecuted, if at all; who in government is responsible for counting and combating them.

You’ll work on stories based in part on the thousands of tips we’ve received, and you’ll collaborate with other reporters at ProPublica and in our partner newsrooms on longer projects.

Reporting fellows at ProPublica have gone on to work at The New York Times, Bloomberg, Politico, NPR, Center for Public Integrity and the Chicago Tribune — as well as ProPublica itself.

This is a special position located with the data team. No data experience is necessary, though you will likely acquire some!

The fellowship runs until the end of 2018, pays $800 per week and includes full benefits. It will be based at our headquarters in New York, and may involve some travel.

We’re looking for someone who:

Has a gift for talking to victims, lawyers and cops, and the talent to tell all their stories well.

Is a fast, clear writer, and is truly excited about all the possible ways we can do journalism nowadays: from deep data-digging, to working with readers, to marrying narrative and investigative forms, to video, etc.

Really likes working with others. Everybody at ProPublica has their own superpower, whether it’s sourcing, document-diving, data, engagement or design. But we do our best work together.

Has experience working with diverse cultures and communities in the U.S. Bonus points if fluent in another language, especially Spanish or Arabic.

We know there are great candidates who won’t fit everything we’ve described above, or who have important skills we haven’t thought of. If that’s you, don’t hesitate to apply and tell us about yourself.

We are dedicated to improving our newsroom, in part by better reflecting the people we cover. We are committed to diversity and building an inclusive environment for people of all backgrounds and ages. Everyone is encouraged to apply, including women, LGBTQ people, people of color and people with disabilities.

What you should send us:

The most important part by far is your past work. We’d also ask that you to submit a memo that describes what interests you most about covering hate crimes. And let us know how your experience (either in life or professionally) has prepared you for this.

]]>Documenting Hate2017-12-11T13:00:00+00:00by ProPublicaWhen Buying Prescription Drugs, Some Pay More With Insurance Than Without Ithttp://tracking.feedpress.it/link/9499/7669604
Sat, 09 Dec 2017 17:01:00 +0000https://www.propublica.org/article/when-buying-prescription-drugs-some-pay-more-with-insurance-than-without-it#137618
by Charles Ornstein, ProPublica, and Katie Thomas, The New York Times

Having health insurance is supposed to save you money on your prescriptions. But increasingly, consumers are finding that isn't the case.

Patrik Swanljung found this out when he went to fill a prescription for a generic cholesterol drug. In May, Swanljung handed his Medicare prescription card to the pharmacist at his local Walgreens and was told that he owed $83.94 for a three-month supply.

Alarmed at that price, Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.

It had struck a better deal than did his insurer, UnitedHealthcare. "It's completely ridiculous," said Swanljung, 72, who lives in Anacortes, Washington.

In an era when drug prices have ignited public outrage and insurers are requiring consumers to shoulder more of the costs, people are shocked to discover they can sometimes get better deals than their own insurers. Behind the seemingly simple act of buying a bottle of pills, a host of players — drug companies, pharmacies, insurers and pharmacy benefit managers — are taking a cut of the profits, even as consumers are left to fend for themselves, critics say.

Although there are no nationwide figures to track how often consumers could have gotten a better deal on their own, one industry expert estimated that up to 10 percent of drug transactions involve such situations. If true nationwide, that figure could total as many as 400 million prescriptions a year. The system has become so complex that "there's no chance that a consumer can figure it out without help," said the expert, Michael Rea, chief executive of Rx Savings Solutions, whose company is paid by employers to help them lower workers' drug costs.

Pharmacy benefit managers, the companies that deal with drug benefits on behalf of insurers, often negotiate better prices for consumers, particularly for brand-name medications, Rea said, but that's not necessarily true for some generic drugs. Insurers' clients are frequently employers overseeing large numbers of workers, and the companies are focused on overall costs. So when insurers seek deals for generic drugs, they do so in batches, reaching agreements for groups of different drugs rather than getting the lowest price on every drug.

As a result of these complicated layers of negotiation, which are not made public, different insurers end up paying different prices for individual drugs. Further compounding confusion for consumers, some insurers require a set co-payment for each prescription — say, $15 or $20 — even when the insurer reimburses the pharmacy at a much cheaper rate.

Several companies have emerged to capitalize on consumer anger over the confusing variations in price. The players include not only Blink Health and its better-known competitor GoodRx, but also veteran businesses like the benefit manager Express Scripts, which recently helped to start a subsidiary aimed at cash-paying consumers. Amazon, the online behemoth, is also said to be considering whether to join the fray.

Last Sunday, CVS Health announced plans to merge with health insurer Aetna, a move that would create a corporate behemoth that many have said would have little incentive to serve the needs of regular people. Some consumers say their experience with CVS already demonstrates how easy it is to fall through the cracks. In one case, a customer whose plan was managed by CVS Caremark, the drug benefit manager, would have had to pay more for a drug through her plan at a CVS than what she ended up paying at the same store, with a coupon from GoodRx.

Representatives for insurers and pharmacy benefit managers say cases like Swanljung's are "outliers." "There are three to four billion generic scripts written a year, and in the vast majority of cases, they are going to get a better deal by using insurance," said Mark Merritt, chief executive of the Pharmaceutical Care Management Association, which represents benefit managers.

A spokesman for UnitedHealthcare, Swanljung's insurer, noted that while Swanljung got a lower price for generic Crestor by using Blink Health, he also takes four other prescriptions, for which he got a better deal through his insurance. (Swanljung gave UnitedHealthcare permission to discuss his situation.) Having insurance is clearly valuable, said the spokesman, Matt Burns. In addition, the co-payment for generic Crestor, also called rosuvastatin, in Swanljung's plan is set to decrease significantly in January, in large part because the price of the drug has dropped this year.

Consumers also may face penalties if they don't use their insurance and pay cash to save money. In many cases, insurers won't let them apply those purchases to a deductible or out-of-pocket spending maximum.

Still, many find that leaving their prescription card at home is worth it. Some have found a better deal even at pharmacies that are owned by their drug plan, like CVS.

Susan Thomson, 55, a university lecturer who lives in Summit, New Jersey, is covered by a high-deductible plan through her former employer. Her drug benefits are managed by CVS Caremark, a subsidiary of CVS Health. For at least a decade, she's been using a prescription lotion called sulfacetamide sodium to treat rosacea, a skin condition.

Last year, each time she filled her prescription at a CVS pharmacy, she paid $75.07. Checking the CVS Caremark website this year, she learned that the cost had gone up to $99.03 (or $81.51 if she used CVS's mail order service).

Investigating further, she found that GoodRx offered the same prescription at the same drugstore for $75.57, without her insurance. The prices were even lower at other pharmacies.

"It just doesn't seem right," she said. "I just feel that the pharmaceutical industry and health care industry are pulling these numbers out of thin air."

Michael DeAngelis, a spokesman for CVS, did not dispute the details of Thomson's experience, but said it is rare and attributed the price disparity to her high-deductible plan. Because consumers are responsible for their costs in those plans until they hit their deductible, DeAngelis said it would take them longer to reach it and they might end up spending more in the long run.

Prices can also vary widely from month to month when consumers pay cash, he said.

Drug-discount cards have been around for decades, and retailers like Walmart have also offered cheap generic drug programs, but both were mainly used by people without insurance.

That is changing. Even as more Americans have health insurance since the Affordable Care Act was passed, insurers are increasingly asking consumers to pay a larger share of their costs. In 2016, about five million people in Medicare hit a stage in which they had to pick up a greater share of their expenses.

Reporters at ProPublica and The New York Times examined whether they could get better prices on 100 of the most prescribed drugs, identified by GoodRx, without using their insurance. ProPublica's prescription claims are managed by OptumRx, a large pharmacy benefit manager owned by UnitedHealth Group; The Times's medication coverage for reporters is managed by Express Scripts.

Both reporters found lower prices on GoodRx for at least 40 drugs on the list (many were drugs that can be purchased for $4 at Walmart, without any coupon).

Blink Health also sometimes beat the insurance out-of-pocket costs, but less often than GoodRx. Blink Health recently suffered a series of setbacks when two of the largest drugstore chains, CVS and Walgreens, stopped accepting its discounts, along with a grocery chain, Publix. In November, Blink Health sued its pharmacy benefit manager, which negotiates its prices, claiming that the company, MedImpact, had violated their agreement. MedImpact has not yet formally responded to the allegations in federal court in New York.

GoodRx, a private company founded in 2010, displays the deals it has with nine pharmacy benefit managers, each offering different prices for different drugs.

"We said, let's see if we can gather all these prices and see if we can exploit the variation in these contracts," said Doug Hirsch, GoodRx's co-founder and co-chief executive, "to see if we can provide better value."

Dr. Brad Wainer, a family-practice doctor in Berwyn, Illinois, said he frequently shows patients their options on GoodRx to see if they can get a better price. "Most of them don't believe me until they go and they find it out for themselves," he said.

Consumers may also pay more if they are covered by plans that require them to pay a set co-payment, no matter the cash price. In some of those cases, the insurers require the pharmacies to send them the difference between what they collect from the consumer and what the insurers have agreed to reimburse the pharmacies.

After a New Orleans television station, WVUE, reported last year on this practice, known as a clawback, lawyers across the country filed lawsuits accusing the insurers — including Cigna, Humana and UnitedHealthcare — of overcharging consumers. The companies are contesting the suits.

Several independent pharmacists said there might be safety issues if consumers buy drugs at different pharmacies. If those prescriptions are filled without an insurance card, pharmacy systems may not catch dangerous drug interactions. "That, to me, is a recipe for disaster," said Craig Seither, who owns Fort Thomas Drug Center in Fort Thomas, Kentucky.

Mary Furman, a retired medical social worker in Charlotte, North Carolina, takes the drug celecoxib, the generic version of Celebrex, to treat her rheumatoid arthritis. When she went to fill a 90-day prescription in April, her pharmacy told her she would owe $96.89 if she used her Medicare plan, offered by SilverScript, run by CVS Health.

Then the pharmacy offered her a deal — $72.25 if she paid cash, a price the worker said was the same the pharmacy would offer any customer. "I was flabbergasted," said Furman, who is 72.

Furman took the deal, and afterward, her husband, Nelson, called SilverScript to report what happened. The representative told Nelson Furman he was "not surprised."

The couple then reported the experience to a company hired by Medicare to investigate fraud, but a representative encouraged her to contact the health plan again.

After reporters sent details of Furman's case to CVS, Nelson Furman said they received a call from the SilverScript president. DeAngelis, the CVS spokesman, blamed the pharmacy for charging the couple more than what their share should have been using their insurance. (Medicare rules require that consumers always get the lower price of their set co-payment and a pharmacy's cash price.)

Now the Furmans are looking at drug coverage for next year, and once again, they see huge variation in prices for that drug and others.

"The prices are all over the map," Nelson Furman said.

]]>Health Care2017-12-09T17:01:00+00:00by Charles Ornstein, ProPublica, and Katie Thomas, The New York TimesHow to Save Money on Your Prescription Drugshttp://tracking.feedpress.it/link/9499/7669605
Sat, 09 Dec 2017 17:00:00 +0000https://www.propublica.org/article/how-to-save-money-on-your-prescription-drugs#137653
by Charles Ornstein, ProPublica, and Katie Thomas, The New York Times

If you’re willing to do a little extra work, it is possible to lower your prescription bills.

A reporter for The New York Times and a reporter for ProPublica both found instances this year in which drugs prescribed for family members could be purchased for less money without using their insurance coverage.

Check Your Coverage

Before you go to the pharmacy, check to see what your cost will be. Most of the big pharmacy benefit managers (the companies that manage your drug benefits on behalf of your insurer) allow you to search for drugs on their websites to see what you’ll owe. This cost will vary depending on whether your plan requires you to meet a deductible, which is a fixed amount before your coverage kicks in, make a co-payment or pay a percentage of the list price. The major pharmacy benefit managers are Express Scripts, OptumRx and CVS Caremark.

Brand or Generic?

Determine whether your drug is a newer, brand-name drug that is sold by one drug maker at a premium, or whether it is a generic product that is often cheaper and sold by multiple companies. If you’re unsure, ask your doctor.

Generic Drugs Give You Options

Several large retailers, like Walmart and Costco, sell generics at discounted prices, like $4 a prescription, which may be less than your insurance is asking you to pay. Some grocery stores, like Publix and Meijer, even give away certain medications — like antibiotics — for free. Pharmacy chains like Rite Aid also offer discounted prices to people who sign up for savings clubs.

GoodRx and Blink Health are two companies that offer discounted rates on generic drugs. GoodRx allows consumers to compare what local pharmacies are charging for a drug (it includes prices from discount stores like Walmart), while Blink Health quotes a single price that it has negotiated. GoodRx offers coupons that consumers bring to participating pharmacies, while Blink Health requires users to pay upfront, then collect their prescription at a nearby pharmacy.

Brand-Name Drugs

Check the website of the drug you’re taking. Some companies offer discounts (often called copay coupon cards) to help cover insured patients’ out-of-pocket costs, at least for the first few months. But people who are covered by government programs like Medicare are prohibited from using these programs, and sometimes the discounts are capped for those without insurance.

Depending on your income, you may also qualify for patient-assistance programs, which are either run by the drug maker or a charity that is financed by the drug maker.

Drug makers do not necessarily offer these programs out of a sense of charity — the programs help boost their bottom line by ensuring that patients will continue on their drugs (while sticking insurers with the bulk of the drug’s bill). And sometimes the help is more trouble than it’s worth. Some discounts are valid for a limited period, leaving patients in the lurch when they expire. Other programs can end without notice. But for those with little other choice, every bit helps.

Also, it never hurts to ask your doctor if there is a similar drug available that may cost you less.

Ask Your Pharmacist for a Deal

Many pharmacies — especially independent ones — offer cash-paying customers prices that are lower than a drug’s sticker price. When handing over your insurance card, it’s worth asking if you can get a better deal by paying cash.

Amanda Farber still doesn’t know why Maryland Gov. Larry Hogan blocked her from his Facebook group. A resident of Bethesda and full-time parent and volunteer, Farber identifies as a Democrat but voted for the Republican Hogan in 2014. Farber says she doesn’t post on her representatives’ pages often. But earlier this year, she said she wrote on the governor’s Facebook page, asking him to oppose the Trump administration’s travel ban and health care proposal.

She never received a response. When she later returned to the page, she noticed her comment had been deleted. She also noticed she had been blocked from commenting. (She is still allowed to share the governor’s posts and messages.)

On the left, a screenshot of what blocked user Amanda Farber sees when she accesses Republican Maryland Gov. Larry Hogan’s Facebook page. Blocked users can’t comment on posts. On the right, a screenshot from a user who is not blocked.

Farber has repeatedly emailed and called Hogan’s office, asking them to remove her from their blacklist. She remains blocked. According to documents ProPublica obtained through an open-records request this summer, hers is one of 494 accounts that Hogan blocks. Blocked accounts include a schoolteacher who criticized the governor’s education policies and a pastor who opposed the governor’s stance against accepting Syrian refugees. They even have their own Facebook group: Marylanders Blocked by Larry Hogan on Facebook.

Hogan’s office says they “diligently adhere” to their social media policy when deleting comments and blocking users.

In August, ProPublica filed public-records requests with every governor and 22 federal agencies, asking for lists of everyone blocked on their official Facebook and Twitter accounts. The responses we’ve received so far show that governors and agencies across the country are blocking at least 1,298 accounts. More than half of those — 652 accounts — are blocked by Kentucky Gov. Matt Bevin, a Republican.

Four other Republican governors and four Democrats, as well as five federal agencies, block hundreds of others, according to their responses to our requests. Five Republican governors and three Democrats responded that they are not blocking any accounts at all. Many agencies and more than half of governors’ offices have not yet responded to our requests. Most of the blocked accounts appear to belong to humans but some could be “bots,” or automated accounts.

Help Us Investigate

If you’re interested in finding out who is blocked in your home state or municipality, check out our reporting recipe.

ProPublica made the records requests and asked readers for their own examples after we detailed multiple instances of officials blocking constituents.

We heard from dozens of people. The governors’ offices in Alaska, Maine, Mississippi, Nebraska and New Jersey did not respond to our requests for records, but residents in each of those states reported being blocked. People were blocked after commenting on everything from marijuana legislation to Medicaid to a local green jobs bill.

For some, being blocked means losing one of few means to communicate with their elected representatives. Ann-Meredith McNeill, who lives in western rural Kentucky, told ProPublica that Bevin rarely visits anywhere near her. McNeill said she feels like “the internet is all I have” for interacting with the governor.

In response to questions about its social media blocking policies, Bevin’s office said in a statement that “a small number of users misuse [social media] outlets by posting obscene and abusive language or images, or repeated off-topic comments and spam. Constituents of all ages should be able to engage in civil discourse with Gov. Bevin via his social media platforms without being subjected to vulgarity or abusive trolls.” McNeill told ProPublica, “I’m sure I got sassy” but she made “no threats or anything.”

Almost every federal agency that responded is blocking accounts. The Department of Veterans Affairs blocked 18 accounts as of July, but said most were originally blocked before 2014. The blocked accounts included a Michigan law firm specializing in auto accident cases and a Virginia real estate consultant who told ProPublica she had “no idea why” she was blocked. The Department of Energy blocked eight accounts as of October. The Department of Labor blocked seven accounts. And the Small Business Administration blocked two accounts, both of which were unverified and claimed to be affiliated with government loan programs.

Many governors and agencies gave us only partial lists or rejected our requests altogether. Outgoing Kansas Gov. Sam Brownback’s office told us they would not share their block lists due to “privacy concerns for those people whose names might appear on it.” Alabama declined to provide public records because our request did not come from an Alabama citizen.

Increased attention on the issue of blocking seems to be having an impact. In September, the California-based First Amendment Coalition revealed that California Gov. Jerry Brown, a Democrat, had blocked more than 1,500 accounts until June, shortly before the organization submitted a request for his social media records.

At some point before fulfilling the coalition’s request, Brown’s office unblocked every account.

Vermont Gov. Phil Scott, a Republican, blocked the activist group Indivisible Vermont on Twitter on Aug. 25. On Aug. 28, Vermont reporter Taylor Dobbs submitted a request for the governor’s full blocked list, shortly after ProPublica’s similar request. Later that day, Scott unblocked the group and released a statement saying the account was “misconstrued as spam.”

Wisconsin Gov. Scott Walker’s office unblocked at least two Facebook users after receiving ProPublica’s request. Here are screenshots they sent us showing that the users have been unblocked:

Screenshots provided to ProPublica by Gov. Scott Walker’s office. On the left, two users are blocked. On the right, they have been unblocked.

In the last year, a series of legal claims have called into question the legality of government officials blocking constituents on social media.

We asked the White House, which is not subject to open-records laws, to disclose the list of people Trump is blocking. Officials there have not responded.

]]>Politics2017-12-08T17:43:00+00:00by Leora Smith and Derek KravitzHere’s How to Find Out If Your Elected Officials Are Blocking Constituents on Facebook and Twitterhttp://tracking.feedpress.it/link/9499/7660313
Fri, 08 Dec 2017 17:43:00 +0000https://www.propublica.org/article/how-to-find-out-if-your-elected-officials-are-blocking-constituents-on-facebook-and-twitter#137945
by Derek Kravitz, Terry Parris Jr. and Leora Smith

Facebook and Twitter have become central parts of our political and civic lives. It’s not just President Donald Trump on Twitter and political ads on Facebook. Politicians and agencies across the country use social media to communicate policy, share information and hear from constituents. Those politicians and agencies also have the ability to block those who comment on their posts.

We were curious about that. So, in August, we filed public-records request with every governor and 22 federal agencies for lists of people blocked on their official Facebook and Twitter accounts. We found that nearly 1,300 accounts were blocked — more than half by Kentucky Gov. Matt Bevin. Bevin’s a Republican, but both Democrat and Republican governors block people.

Read More

We filed public-records requests with all 50 governors and 22 federal agencies. Here’s what we found.

When the administrator of a public Facebook page blocks an account, the user can no longer comment on the page. That can create an inaccurate public image of support for government policies.

If a city council member, mayor, state representative or governor is blocking or curating their constituents on Facebook and Twitter, that’s important for local reporters to know. Who are these elected officials blocking? Why? And how many? You don’t have to be a reporter, either. California paralegal Angela Greben has submitted dozens of requests for social media block lists and publicizes them on her blog, “Government Block Lists Revealed.”

We’ve laid out below how you can find out if elected officials are blocking anyone. If you have questions about any step in the process, email us at getinvolved@propublica.org.

Step 1: Figure Out the Law

Look up the relevant open-records laws to make sure that your request includes everything the law requires and that the official or agency are subject to these requests. The Reporters Committee for Freedom of the Press maintains a database of open-records laws by state.

There are differences between states. For example, Michigan’s Freedom of Information Act exempts the governor’s office, legislature and others from the state’s open-records law. The Center for Public Integrity has a helpful state-by-state ranking of public access to government records.

These governors’ offices and federal agencies at least partially responded to our requests for blocked social media accounts.

Governors’ Offices

California Gov. Jerry Brown, Democrat

Colorado Gov. John Hickenlooper, Democrat

Georgia Gov. Nathan Deal, Republican

Florida Gov. Rick Scott, Republican

Kentucky Gov. Matt Bevin, Republican

Maryland Gov. Larry Hogan, Republican

Missouri Gov. Eric Greitens, Republican

Montana Gov. Stephen Bullock, Democrat

Nebraska Gov. Pete Ricketts, Republican

Nevada Gov. Brian Sandoval, Republican

New Mexico Gov. Susana Martinez, Republican

North Carolina Gov. Roy Cooper, Democrat

Oregon Gov. Kate Brown, Democrat

Rhode Island Gov. Gina Raimondo, Democrat

South Carolina Gov. Henry McMaster, Republican

South Dakota Gov. Dennis Daugaard, Republican

Vermont Gov. Phil Scott, Republican

Washington Gov. Jay Inslee, Democrat

West Virginia Gov. Jim Justice, Republican

Wisconsin Gov. Scott Walker, Republican

Wyoming Gov. Matthew Mead, Republican

Federal Agencies

Department of Energy

Department of Labor

Department of Veterans Affairs

U.S. Small Business Administration

U.S. Trade Representative

Here’s the information we requested from the governor of Florida. You can use it as a template for your requests:

A list of all Twitter accounts blocked by @FLGovScott (the official Twitter account of the governor of Florida)

All direct messages sent or received by @FLGovScott (the official Twitter account of the governor of Florida)

A list of all Facebook accounts blocked by Governor Rick Scott (the official Facebook account of the governor of Florida)

A list of all Facebook accounts blocked by Rick Scott (the personal Facebook account of the governor of Florida)

All direct messages sent or received by Governor Rick Scott (the official Facebook account of the governor of Florida)

All direct messages sent or received by Rick Scott (the personal Facebook account of the governor of Florida)

You should include instructions about how to get all of the information requested. For example: “Blocked Twitter accounts can be accessed when logged to any account by going to https://twitter.com/settings/blocked.”

Step 3: Wait...

Response times vary wildly. Some of our requests took a matter of days. Others took months. And still others haven’t responded yet.

Federal agencies and many states are required to acknowledge receipt of your request within 20 working days. If your records can’t be produced in that time, some states are supposed to let you know if they need more time. Whatever you do, keep track of your request.

Step 4: Prepare for a Back-and-Forth

Getting public records often means enduring delays and runarounds. Of the 72 open-records requests that ProPublica sent to governors and federal agencies about social media blocking, seven refused our requests or provided only partial information. Some examples:

Outgoing Governor of Kansas Sam Brownback’s office told us they would not share their block lists due to “privacy concerns for those people whose names might appear on it.”

Alabama declined to provide public records because ProPublica’s request did not come from an Alabama citizen.

Wyoming provided their Twitter block lists, but no Facebook information.

Georgia sent copies of direct messages received by the governor’s Twitter account, but nothing else.

Florida also only sent a list of accounts blocked on Twitter. While a verified “public figure” account for Rick Scott does exist, and is regularly updated with press releases from the governor’s office, the office says the account is run by Scott’s political team and is not subject to public-records requests.

Gov. Eric Greitens’ office in Missouri also declined to share records from the governor’s Facebook or Twitter accounts, saying neither are “considered to be the ‘official’ social media accounts of the Governor of Missouri.”

The government’s vast seizure of private property to build a border fence a decade ago provoked cries of abuse and unfairness. Will it all be repeated if Trump gets his wall? A ProPublica/Texas Tribune investigation starts Dec. 14.

After Hurricane Irma hit three months ago in Orlando, Florida, the local police got a desperate 911 call from a 12-year-old boy reporting that his mother and siblings were unconscious. Fumes overcame the first deputy who rushed to the scene. After the police arrived at the property, they found Jan Lebron Diaz, age 13, Jan’s older sister Kiara, 16, and their mother Desiree, 34, lying dead, poisoned from carbon monoxide emitted by their portable generator. Four others in the house went to the hospital. If 12-year-old Louis hadn’t made that call, they might have died, too.

Portable generators release more carbon monoxide — which is particularly dangerous because it is odorless and invisible — than most cars. As a result, the devices can kill efficiently and quickly, though accidentally. The Diaz family usually placed the generator properly, outside the house, a neighbor told local reporters. But for some reason, they had brought it into their garage. From there, the generator’s murderous byproduct spread silently through the house.

During hurricanes, floods, and nor’easters, portable generators save lives — except when they take them. Irma, Harvey, and Maria all left thousands without power and reliant on their portable generators. The government has not yet done its official count, but 11 people using these generators died just from Irma, according to preliminary government estimates. Many more died from Harvey and Maria, experts say, especially in Puerto Rico, which has been without a functioning power grid for months.

These deaths rarely merit more than short stories on local news sites. Civil servants then accumulate the statistics into dry reports that end up buried somewhere on .gov websites. The latest of these shows that portable generators have killed on average 70 people a year since 2005. That’s a small fraction of the toll from car accidents. Still, generators rank as one of the deadliest consumer products on the market. A further 2,800 people a year suffer from carbon monoxide poisoning caused by the equipment.

Portable generator deaths are preventable, and for the past 16-plus years, the United States government has tried to do just that. The job has fallen to the Consumer Product Safety Commission, which, with its $126 million budget and 520 employees, oversees almost every product Americans use in their home, office, or out in the yard, save for food, drugs, and cars. The CPSC, based in Bethesda, Maryland, is tiny, especially compared to many of the corporations it regulates, and hamstrung by Congressional rules that require it to seek voluntary standards before attempting to impose mandatory ones.

But the problem of portable generators was so obvious that the little agency felt it needed to make a stand. They were one of the “persistent deadly hazards we felt we had to address,” says Elliot Kaye, who was the chairman of the CPSC from 2014 to February of this year and remains a commissioner. (The CPSC has five commissioners who vote on agency measures; the party that controls the White House tends to have the majority.)

Throughout the 16 years the CPSC has been pushing the issue, the portable-generator industry fended off regulations that would have required it to reduce the carbon monoxide emissions of its devices. The companies argued such changes would be too costly, and that they lacked the technology to make the machines safer. The industry lobbied hard, and also wielded an arsenal of delaying measures and misdirection, not to mention occasional strong-arm tactics to enforce industry discipline, its critics say.

But in early November 2016, during the final months of the Obama administration, the CPSC took one of the most significant steps it can take: The commission voted in favor of a rule to force manufacturers to lower their generators’ carbon monoxide emissions. The vote was 4 to 1, with one Republican joining the majority of Democrats.

Donald Trump was elected a week later. In January, he elevated the only commissioner to vote against the rule — Ann Marie Buerkle, a 66-year-old former Republican congresswoman from upstate New York — to be the acting chair of the CPSC, and she took on the role in February. (She awaits Senate confirmation to become the chair.) The administration has nominated, as a potential commissioner, a lawyer from the corporate firm Jones Day who specializes in defending companies from product-liability cases; one other vacancy remains. So Buerkle will likely soon have new allies.

Self-effacing and warm, Buerkle wins universal praise from agency employees and fellow commissioners as a pleasant colleague. Even the Democratic appointees feel she listens to them. Indeed, the CPSC took pride that it wasn’t riven by the partisan rancor that infects so much of Washington. Kaye, a Democrat, brought his family to visit fellow commissioner Buerkle and her family when they vacationed in upstate New York.

Buerkle’s gentle personality, however, belies hardline views on regulation. Buerkle has never, in her fellow commissioners’ recollection, advocated for the agency to regulate a product that the CPSC staff thinks is unsafe. She is a government regulator who doesn’t appear to believe in government regulation.

Voluntary standards are “a better way to go,” Buerkle told ProPublica. “They are quick to complete. There’s much more efficiency in implementation. And there’s much more buy-in from stakeholders.” Never mind that in this instance it took more than a decade, and ongoing government prodding, for companies to get close to adopting a voluntary standard of its own. Pressed on which product hazards are her priorities, Buerkle says: “Fidget spinners are a big deal.” (They should not be placed in the mouth, the commission warns.) She also mentions children’s products and toys, pool safety, and portable generators.

Among her first actions as chair, Buerkle did two things. She sent a letter in August to Scott Pruitt, the head of the Environmental Protection Agency, agreeing with his assertion that the CPSC does not have the legal authority to make a rule about carbon monoxide emissions from portable generators.

In a second move, Buerkle appointed Patricia Hanz to be her general counsel. Hanz comes from Briggs & Stratton, a manufacturer of engines in Wauwautosa, Wisconsin, where she was the assistant general counsel. Briggs & Stratton, which brings in $1.8 billion a year, happens to be one of the biggest portable-generator manufacturers in the world. Hanz also served as the vice president of the portable-generator trade group.

The rise of Hanz and Buerkle — and the issue of portable generators — has injected a new contentiousness into the CPSC. In an impassioned speech in October, decrying the future of her agency, CPSC commissioner Marietta Robinson called Hanz “the one person who fought the hardest against any safety measures” for portable generators.

Hanz declined to comment on a detailed list of questions. In a statement from the CPSC’s public-affairs office attributed to Hanz, she said she has recused herself. “Under the Trump Administration Ethics Pledge I cannot have any involvement with my former employer, nor with PGMA (Portable Generator Manufacturers Association) for two years, including contracts and regulations. In addition, to avoid any appearance of partiality, I will have no involvement in matters related to any PGMA members,” she wrote in an email. Briggs & Stratton also declined to respond to detailed questions. The company said in a statement it “is and has always been committed to safe operation of generators.”

While Trump has achieved few of his legislative priorities, his administration is succeeding in broadly eroding federal regulation. Having fought the long war, the portable generator industry is now poised to benefit from the president’s success. The government’s portable-generator rule has not been finalized — and now with Buerkle at the helm, it probably will never be.

The Consumer Products Safety Commission’s efforts to fix portable generators owe their origins to what now seems like a silly panic just before the turn of the century. In the lead-up to the year 2000, people worried that computers wouldn’t be able to process, in their databases, the transition from the year 1999, a theoretical calamity referred to as the Y2K problem. If they went on the fritz, some predicted, the country might face catastrophes like mass blackouts. Regulators worried that people would rush out to buy portable generators, leading to a spike in carbon monoxide deaths.

Y2K passed without incident, and those who purchased generators to protect against the apocalypse sheepishly stored them away unused. But the CPSC realized that it should do something about needless carbon monoxide deaths. Portable generators were killing more people than all heating systems combined.

When the CPSC thinks about regulating products, it considers what it calls a “safety hierarchy.” The best solution is to design a product that is safe. Not all products, of course, can be perfectly safe — cars must go fast and table saws must be sharp. So the second-best remedy in the hierarchy is to mitigate the risk with, say, airbags or hand-guards. The third option is a warning label, but the CPSC staff typically views that as least desirable because people often don’t abide by the warnings.

In 2002, the commission contacted Underwriters Laboratories, a private company that tests product safety and helps develop industry standards, to see if it would help companies make safer generators. Seeing the government moving, the manufacturers began, with reluctance, to place warning labels on the machines. At the time, the companies claimed, a label that cautioned people not to operate the machines indoors was as far as they were able to go: The technology, they asserted, did not exist to make a generator engine that emitted less carbon monoxide.

The CPSC staff was happy enough at the time because third-best is better than nothing. Still, in the case of portable generators, the instructions can produce confusion. They tell consumers not to operate them indoors, but also not to let the machines get wet, which would seem to rule out placing them outside in many cases. Given that people tend to use their generators precisely when weather conditions are snowy or torrential, this is hard advice to follow. Some users solve this conundrum by doing things like putting the generator on their porch or in their garage. Sometimes people have not put their generators far enough outside: More than a quarter of portable generator deaths occur from these sorts of placements.

The companies were not sympathetic, says CPSC commissioner Kaye. His impression of the industry view was: “If consumers are too stupid to read the label and they die, that’s their fault.”

In the short term, adopting the labels had one positive effect — at least for the manufacturers: It staved off stricter regulation for several years. Unfortunately, it was a different matter for consumers. The labels had no apparent effect. The number of carbon monoxide deaths and injuries caused by generators did not decline.

The continuing deaths were disturbing enough that in 2006, under the George W. Bush administration — no fan of regulation — the CPSC decided to take more significant steps. The CPSC began work on a mandatory rule requiring manufacturers to make their machines safer. How the industry got there would be up to them. Companies could develop engines with lower emissions or install switches that automatically shut off the engine when carbon monoxide levels got too high. The agency produced what it calls an “Advanced Notice of Proposed Rulemaking,” announcing its intentions and allowing the public to comment.

Comments flowed in, especially from the industry. In February 2007, manufacturers wrote to the CPSC urging it not to impose a mandatory standard. They said it would be costly. They also raised questions of whether the CPSC even had the power to require engines with low emissions. As for shut-off switches, the companies warned that “the presence of such [carbon monoxide] detections capability may create a false sense of security,” lulling consumers into thinking they don’t need to take other precautions. One of the three signatories was Patricia Hanz, then working for Briggs & Stratton.

But with the warning label clearly no longer placating the government, the industry gave some ground, agreeing to begin developing its own voluntary standard in the hopes of avoiding a stricter mandatory standard from the government.

For the next three years, little happened. Underwriters Laboratories, today known as UL, again tried to help the industry come up with its voluntary standard, but in 2009, as UL worked toward guidelines manufacturers considered too stringent, they decided to go their own way.

The companies created their own trade group, the Portable Generator Manufacturers Association. The PGMA launched its own initiative to create a voluntary standard. But the CPSC remained skeptical. One problem was that the PGMA’s members don’t sell all the generators purchased in the U.S. Other makers wouldn’t be bound by anything that body came up with. (Today, the PGMA says it represents 80 percent of the market, which manufacturers I spoke to estimate to be anywhere from $700 million to $1 billion.)

The following year — a decade after the CPSC began trying to prevent deaths from carbon monoxide poisoning — the PGMA held its first technical committee meeting to discuss the safety of portable generators. Among the attendees was Michael Gardner, the vice president of new product development at Techtronic Industries, a maker of generators and other products (including Hoover and Dirt Devil vacuum cleaners). He waited for a discussion of carbon monoxide emissions. And waited.

Nobody ever brought them up. “The one topic the technical committee was not talking about — the elephant in the room — was the roughly 70 people dying [each year],” Gardner says. “The technical committee was established to write the safety standard but it did not include carbon monoxide in that standard.”

Carbon monoxide poisoning is far and away the chief safety concern from portable generators. Nothing else comes close. But Hanz, then on the PGMA board of directors, argued that the industry should figure out all the easy things first, rather than tackle the most contentious issues right away.

With the voluntary standard going nowhere, the CPSC decided it needed to conduct the manufacturers’ research and development for them. It sent out a proposal asking for engineers to try to solve the problem. The University of Alabama answered, and came up with a prototype for a safer generator. In October 2012, the CPSC gave a technology demonstration to the industry showing the new engine could lower emissions by more than 90 percent.

Many of the companies scoffed. They argued the prototype was unproven and unreliable, and that the University of Alabama results were obtained in unrealistic conditions. They even suggested the new engine might be dangerous, giving users the sense that they needn’t worry. One company, however, embraced the new ideas: Techtronic. “That was a tipping point for us to say it can be done,” Gardner says.

Not until September 2014 did the PGMA release an initial voluntary technical safety standard for manufacturers. The detailed list included provisions for durability (generators had to survive being dropped from a height of eight inches onto a concrete surface); temperature tolerance (wind speed less than 6.7 miles per hour during testing), and rain resistance (a generator must be soaked, wiped off, and then run for 15 minutes).

But the standard was mute about the emissions that could kill customers. The CPSC sent a politely worded letter in January 2015 that the “staff notes with concern” that the proposal’s only mention of carbon monoxide was in the context of warning labels and external carbon monoxide monitors. On average in the three years through 2012 (the most recent year for which official data is publicly available — the government’s death-count lags as the tally only becomes official years later), carbon monoxide from portable generators killed 63 people per year. The CPSC’s displeasure carried a threat to the industry: If it didn’t get moving, the commission would move forward on its own mandatory standards effort.

To confront this threat, the industry countered with one of its own. In March 2014, the PGMA sent a letter to the commission insisting that it was “not appropriate” for the CPSC “to establish a working group” on the issue, statements that carried the implication it might sue the government if the commission tried to implement a mandatory rule. At that point, the PGMA finally formed two groups of its own to examine two engineering solutions: a low-emissions engine based on the University of Alabama prototype and an automatic shut-off valve. Most of the manufacturers, if pressed, preferred adding shut-off valves; they’re much cheaper. After two meetings, the PGMA picked that option and discontinued the group aimed at looking at lowering emissions.

A year later, the PGMA was ready to show off its progress. In March 2016, the trade group hosted a technical summit. Representatives from manufacturers flew in from all over the country. But only one PGMA member made a presentation regarding a new low-emission generator: Techtronic’s Gardner. In front of a crowd that included manufacturing employees, lobbyists, CPSC staff, and one CPSC commissioner, Republican appointee Joseph Mohorovic, Gardner demonstrated that the low-emissions technology worked. Techtronic’s engine produced 90 percent less carbon monoxide than a similar machine.

When Gardner finished, he looked around the room and heard nothing but silence. Then, in a scene out of “Citizen Kane,” he heard one lone person begin to clap: Mohorovic. After the talk, the commissioner stood up, came over, and shook Gardner’s hand.

At the meeting, someone asked whether companies were going to introduce a low-emissions engine, and if so when. Briggs & Stratton’s Hanz said it would be many years, perhaps five or six. Not so, Techtronic said. It was planning to introduce one in 2017.

Finally, in October of last year the time had come. American society makes bargains with its machines. The country is willing to pay, sometimes in lives, for less expensive and more convenient products. But this deal seemed, to the government, too costly.

To make any rule, the CPSC is required to conduct a cost-benefit analysis. In this case, the commission estimated that new portable generator restrictions would save $145 million annually, accounting for the government-computed value of the lives saved. (The industry took issue with those figures.) The commission rarely votes on mandatory rules. Indeed, Congress requires the agency to try to get industries to implement voluntary standards first. But the portable generator makers had not done so.

The commissioners concluded they had no choice. They voted on a Notice of Proposed Rulemaking (NPR), a big — but not final — step toward a mandatory rule. It required manufacturers to build low-emissions machines. The CPSC staff said it was the best alternative. After investigating four different shut-off technologies, they determined that option was “not feasible.” With Mohorovic joining the Democrats, the vote was 4 to 1.

“Our staff engineers spent well over a decade trying to get manufacturers to make portable generators safer and all but a couple steadfastly refused to do so,” says Marietta Robinson, a commissioner appointed by President Obama. “This NPR was absolutely essential in forcing manufacturers to do the right thing to save lives.”

Meanwhile, the manufacturers were still dithering on a voluntary standard. They couldn’t even agree on how to measure how much carbon monoxide their engines emitted. In April of this year, UL tried to take a preliminary step; it proposed a uniform method for measuring emissions. Techtronic lobbied for it. Briggs & Stratton pushed against it. Things got heated: At one point, a Briggs & Stratton employee labeled Techtronic a “rogue company” in an email circulated to PGMA members. During the voting, some manufacturers changed their position, from being for the standard to being against. Briggs won and the measure was narrowly defeated.

Today, with Buerkle as chair, the fate of the mandatory standard seems doomed. She has already voted against it once, and stated that the CPSC has no power to regulate generators’ carbon monoxide emissions. Installing Hanz as general counsel has only made some CPSC officials more pessimistic about regulating portable generators. Buerkle says Hanz is qualified and that her appointment was fully vetted by ethics officials.

Nearly two decades after carbon monoxide concerns first arose, the industry says it is close to a voluntary standard. Even this move has twists and turns. PGMA is working on a less stringent guideline, only requiring a shutoff sensor. It is aiming to have it completed by this year.

At the same time, UL circulated a competing, stricter measure, requiring both a shutoff sensor and a low-emission engine. Again, members lobbied intensely. The nay votes had a surprising supporter: Mohorovic. The Republican commissioner has left the CPSC and taken a job at the law firm Dentons. And he has flipped from the position he held as a public servant. He now is against a low-emissions engine, sending a series of emails attacking UL’s standard and urging members to vote against. “There is no evidence, data or modeling” that UL’s standard will save lives, he wrote recently in an email to one voter. (He did not respond to questions about why or who his client was.)

Buerkle, too, advocates for a shutoff sensor. She contends they are the safer alternative. “I’m told by CPSC staff,” she says, that “shutoff technology will be far more effective” in saving lives. She says the staff told her that shutoff switches would reduce the figure by somewhere around 99 percent.

But in fact that 99 percent figure is an industry estimate. The CPSC acknowledges that it has neither calculated how many deaths the shutoff valves will save, nor concluded that they’re more effective at saving lives than low-emission technology. The staff at the commission has worried that carbon monoxide can migrate away from a machine such that it kills without ever triggering the shutoff switches. And staffers worry that the switches might trigger bothersome shut-offs, leading consumers to disable the switches. The industry says it has resolved those concerns, but Techtronic takes issue with the figure. Calling PGMA’s 99 percent claim “misleading,” the company says it has not been peer-reviewed and doesn’t account for many scenarios when portable generators are used.

Buerkle is satisfied with the industry’s progress: “I’m just happy where we are right now. We are on the verge with technology that will save lives.”

Others at the CPSC remain skeptical. “I am extremely concerned that backing off now, as our chair and general counsel have made clear they intend to do, will, at a minimum, delay these life-saving efforts and, perhaps stop them altogether,” says Robinson, the Democratic commissioner whose term has expired. (She will leave when her replacement is confirmed.) But with Buerkle’s ascendancy, there’s not much Democratic commissioners can do.

The industry says some manufacturers aim to start marketing machines with shutoff switches next year. “This should be a good news story that industry stepped up to do the right thing,” says Edward Krenik, a lobbyist who represents the PGMA. “Though it took a while.”

For its part, Techtronic kept its promise to put a low-emissions generator on the market. They’re available now — and they sell for less than many other competing products. But to the industry, that makes Techtronic an outcast.

About 700 to 900 women die each year from causes related to pregnancy and childbirth. And for every death, dozens of women suffer life-threatening complications. But there is a stark racial disparity in these numbers. Black mothers are three to four times more likely to die than white mothers. Nevertheless, black women’s voices are often missing from public discussions about what’s behind the maternal health crisis and how to address the problems.

It is estimated that up to 60 percent of maternal complications are preventable. One way to prevent them is to talk to and learn from women who have nearly died from these complications. So, we reached out to nearly 200 black mothers or families that shared stories of severe complications as part of our maternal health investigation Lost Mothers.

Maternal Complications

Since this disparity has existed for decades, we were interested in learning how it might have affected generations of black women — and maybe even women in the same families.

We also know difficult conversations can sometimes be easier with a loved one. We asked women if they would be willing to discuss their near miss with their mother or daughter.

To help navigate these tough conversations, we gave each pair of women a tailored set of questions and got out of the way (you can download a copy of the questions here). We spent an hour recording them, some in their living rooms and others over the phone. We’ve organized these conversations by the complications each woman faced. We included several generations of women from 6 to 64 years old.

Postpartum Hemorrhage

A postpartum hemorrhage (PPH) occurs when a woman experiences heavy blood loss after giving birth. In developed countries, pregnant women nearly die from this complication more than any other. The most common cause of PPH is uterine atony, which means the uterus isn't contracting effectively after delivery. However, having fibroids (benign tumors in the uterus), any kind of infection or a systemic blood clotting disorder can also cause PPH.

Heather and Avis

Avis Glover was integral in the recovery of her daughter Heather Dobbs, who nearly died due to a hemorrhage in 2017.
(Joanie Tobin for ProPublica)

Heather Dobbs was 41 weeks pregnant when she went into a prolonged labor. Eventually she was induced and had an emergency cesarean section at a hospital near her home at the time in rural Texas. Dobbs, 37, an educator and editor now living in Covington, Georgia, says there were no further complications. After the C-section, both Dobbs and her new son Cameron were fine and went home.

Two years later, in 2016, Dobbs was pregnant again. Because of her emergency C-section with Cameron, she was scheduled for another C-section and could plan the birth of her second child. She picked Feb. 8. It was two days before her own birthday. Dobbs was excited and felt prepared to welcome her first daughter, Claire, into the world.

Then came the uterine atony. During her C-section, her doctors said her uterus was “boggy” — it was soft, enlarged, floppy and would not contract as it was supposed to. It also wouldn’t stop bleeding.

Heather:Listen They were just bringing fluid after fluid, after fluid bag, and I finally said to myself: You cannot die on this table before you get to hold your daughter. And that’s the last thing I remember.

Claire was born healthy. But Dobbs’ postpartum hemorrhaging — as a result of uterine atony — forced the doctors to perform a full hysterectomy.

Heather:Listen And then, the doctor came in to talk about the hysterectomy with me. And, I just remember ... you know how you watched Charlie Brown, and it's like, womp womp womp womp womp womp. It's like, what is she saying? I knew it was serious, but they had to eventually call her back in to re-explain. “You were bleeding out. You lost a tremendous amount of blood, and you had to ... We had to take your uterus.”

The emotional toll of the hysterectomy and the complication that caused it led to postpartum depression. The support of her mother — Avis Glover, 63, a career nurse, who had two C-sections herself — has been important in her recovery.

Avis: How do you manage, you think, with the long-term effects of your experience?

Heather: Listen At my darkest hour, it was like why plan anything? Everything’s just going to go however it goes anyway. You don’t have any control, so that was really difficult. But then at the same time, it made me aware, you have two kids that you have to care for now. And in caring for them, you must care for yourself, so you can’t have the anxious mom, and the depressed mom, you have to treat it.

Fibroids and Preeclampsia

Fibroids are benign tumors in the uterus. They are most common in 30- to 40-year-old women. Fibroids, however, are three times more likely to occur in black women than white women. They also tend to occur at younger ages and grow more quickly in black women, causing more severe symptoms — like heavy menstrual bleeding and pelvic pain — contributing to complications such as postpartum hemorrhage.

Preeclampsia occurs when a woman with normal blood pressure develops high blood pressure during pregnancy and when protein is found in the urine. Left untreated, preeclampsia can lead to other serious complications for both the mother and the baby. Preeclampsia affects at least 5 to 8 percent of pregnancies. When black women have preeclampsia, it presents earlier than in women of other races.

Wanda and Asha

Asha Ivey-Stephenson, 37, and Wanda Irving, 64, became friends through Wanda’s daughter, Shalon Irving. The three first met in Michigan in 2002 while Asha and Shalon visited graduate school programs they were interested in attending. Years later the friends reconnected in the Atlanta area where they both settled. Close in age, both wanted to become mothers. Ivey-Stephenson would be the first. She got pregnant in 2015 when she was 35 years old. Ivey-Stephenson has fibroids, a complication that affects 80 percent of black women. No one knows what exactly causes fibroids or why black women are so susceptible.

Ivey-Stephenson’s fibroids kept her in the high risk perinatal unit for a month and a half. Her stay was so long that Ivey-Stephenson had her baby shower at the hospital. In mid-December she delivered a healthy baby boy.

Asha:Listen This is something that Shalon and I actually bonded over. She helped motivate me through as well. My challenges that I was referring to primarily stemmed from my uterine fibroids and it’s something that African-American women deal with. The majority of my friends have, whether it’s small, large, multiple fibroids. It’s something that my mother had, so I knew that most likely I’d have it.

Five days after she delivered, just as she was about to leave the hospital, Ivey-Stephenson’s blood pressure skyrocketed.

Asha:Listen There were points where [my blood pressure] got so high, we were all not sure what was going to happen. When I got home, I had to have physical therapy, occupational therapy and regular nursing. Occupational therapy and regular nursing came to the house because I had lost so much muscle tone. Basically I couldn't walk. So I had to learn all that over again. And it was just, trying to do that plus trying to breastfeed, trying to do all these different things was challenging.

During all of this, Irving was part of her network of supportive friends.

A little over a year later, in January 2017, Irving celebrated the birth of her first child — a baby girl she named Soleil. But Irving was a mother for just three weeks. Her postpartum complications became increasingly serious. She ultimately died due to complications from high blood pressure. Soleil was left in the care of Irving’s mother, Wanda. Ivy-Stephenson has stayed close to the family. Wanda sat down with Ivey-Stephenson to share this conversation, and her advice for other expectant black women.

Wanda:Listen My one regret is that Shalon told me once, she says, “I know my body. I know there’s something wrong,” and that’s what I would recommend to every black woman, if you know there’s something wrong, please don’t stop until you find someone who will help you figure out what’s wrong, and not just take a lot of the paternalistic kinds of answers or the general answers, “Oh well it’s nothing. It comes along with pregnancy,” or “It's part of childbirth,” or it’s part of whatever. You know your body better than anyone else. You live in that body. If there is something you’re feeling that’s wrong, then do something.

Uterine Rupture

A uterine rupture is a tear in the wall of the uterus. While rare, this complication is dangerous not just for the mother but for the child. When the uterus tears, the unborn baby can be expelled into his or her mother’s abdomen. The baby can be deprived of oxygen and the mother can experience severe blood loss. A well-known risk factor for a uterine rupture is a uterine scar. Most uterine scars arise from a prior cesarean delivery.

Brenda and Heather

During a family visit to Durango, Colorado, Heather Lavender and her mother, Brenda Bagby, recorded this conversation.
(Courtesy of Heather Lavender)

In March 2014, Heather Lavender was 32 and nine months pregnant when she went into labor. Her mother, Brenda Bagby, her sister, Melissa, her doula, and her son’s father rushed Lavender to Johns Hopkins Hospital in Baltimore where she was also an intensive care nurse.

After many hours of labor, she had a pain in her abdomen, which gradually became unbearable. That pain turned out to be a uterine rupture. After an emergency C-section to deliver the baby, doctors had to perform a hysterectomy to stop the massive blood loss.

Heather:Listen You know as long as my baby is OK, you know ... God can’t be that cruel to have me lose my uterus and my baby all at the same time. So at that point I was just really hoping and praying that my son would be OK.

The rupture, however, was catastrophic for her son. Cruz ended up outside of the womb and without oxygen. As a result, he suffered severe brain damage. When Cruz was born he never moved, opened his eyes or cried.

Brenda: How are you different now than before your complication?

Heather:Listen I think for most of my life I’ve been a pretty positive person and I just don’t feel that way about myself anymore. I feel purposeless, I don’t feel that I have like true joy in my life, I don’t care. I pray for an early death. I don’t want to live to be an old person ... and I know it’s wrong.

Cruz lived nine days on a ventilator in the neonatal intensive care unit before Lavender and her family decided to remove him from life support.

When Cruz was born he never moved, opened his eyes or cried. He lived nine days on a ventilator in the neonatal intensive care unit before his mother and her family decided to remove him from life support.
(Courtesy of Heather Lavender)

Heather: How do you remember my son Cruz, your grandson?

Brenda:Listen It’s hard sometimes, I couldn't stand the sound of the machinery after a while. I just wanted it to stop, I didn’t want to hear more beeping. No more alarms. So I am glad we got to have a little bit of time without all of that. And when they extubated him, when they removed him from the breathing tube it was clear that he wasn’t going to be able to be with us for very long. So being able to go home and have that quiet time with him that we wouldn’t have had otherwise was really a blessing and having the pictures that we have from that helps me every day.

In 2016, Lavender moved from Baltimore, Maryland, to Farmington, New Mexico. This conversation was recorded during a visit from her mother who lives in Cleveland Heights, Ohio. Lavender continues to practice as a nurse.

Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection, or SCAD, often occurs late in the pregnancy or during the postpartum period. It’s when a tear forms in one of the blood vessels in the heart. It can slow or block blood flow, causing a heart attack, abnormalities in heart rhythm or sudden death. Hormonal changes during pregnancy are thought to trigger this complication. Despite treatment, it may recur soon after the initial tear or even years later.

Candice and LaVerne

LaVerne Maynard rushed her daughter, Candice Williams, to the hospital five days after the birth of Williams' first daughter in 2011.
(Courtesy of Candice Williams)

As in most SCAD cases, Candice Williams, a high school teacher, was healthy throughout her pregnancy. She was 30 at the time. She did not have a heart condition or a previous history of hypertension. But five days after giving birth to her first child, Aniston, in 2011, she nearly died.

Aniston is now 6 years old and wanted to ask her mother this:

Aniston: How did you get your heart attack?

Candice:Listen That’s a good question baby, doctors aren’t really sure. I've seen at least four doctors related to the heart attack and all they can tell me is that it is a rare occurrence and that it has something to do with my hormones so when I had you my hormones were unstable as women’s hormones are after they give birth so I guess that caused my heart to start hurting baby but it wasn’t your fault.

Williams, now 37, was home from the hospital when her chest started to hurt. The pain got so bad that her mother, LaVerne Maynard, rushed Williams to a nearby hospital in El Centro, California. Because that hospital wasn’t equipped to treat Williams, she was airlifted more than 100 miles to a hospital in San Diego.

LaVerne: What is the hardest moment for you?

Candice:Listen The hardest moment was probably being life-flighted and I only remember parts of it, I guess I was really scared and I kept thinking about Ani and if I ... if something happened to me, I had no idea what was going to happen to my baby. So that was the hardest moment. It’s still the hardest moment.

After more tests, doctors concluded that she had experienced a SCAD. Rather than operate on her, they gave her blood thinners, beta blockers and aspirin to prevent another attack and help heal the heart on its own. She was hospitalized for four days and released.

Candice:Listen I had a relatively good diet, I was not overweight and SCAD often happens to women who don't have any prior health issues. So people think because I had a heart attack that I had high blood pressure or I didn't eat right or didn't exercise but I was actually the opposite of that.

After surviving this SCAD, her doctors advised against a second pregnancy. But, five years later, in March of 2016, Williams gave birth to a second daughter, Leah. This time, she had no complications. Williams pays more attention to her body now. She takes blood pressure medication once a week, sees her cardiologists every six months, exercises, and watches what she eats.

Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a form of maternal heart failure. It’s when the heart isn’t strong enough to pump enough blood to the vital organs so they can function properly. A mother may experience PPCM up to six months postpartum. On average, PPCM affects black women at a younger age (27.6 years old) than non-black women (31.7 years old). And despite similar rates of treatment, the recovery time for African-American women was at least twice as longas that of other women. Little research has been done to understand the differences in severity and recovery.

Jennifer and Anner

Anner Porter visited her daughter, Jennifer Reid, in Atlanta, where they recorded this conversation about Porter’s 25-year battle with PPCM.
(Courtesy of Anner Porter)

In 1992, about a month after Anner Porter gave birth to her second child — a boy she named Norris — she was at the OB-GYN complaining of exhaustion and numbness. She said she was told to eat some beets to improve a low iron count. Two days later, Porter nearly died. Her heart failed to pump enough blood to keep her vital organs going. This is called postpartum cardiomyopathy (PPCM).

That was the first time Porter had heard of PPCM — from an emergency room doctor diagnosing it as her organs started to shut down. Ever since that postpartum heart failure 25 years ago, Porter has suffered heart complications.

Jennifer: Tell me what happened in the postpartum period that changed your life?

Anner:Listen Oh wow, OK. Twenty-eight days later I still found it extremely difficult to function. I was extremely fatigued. Was constantly experiencing shortness of breath. Coughing all the time unable to lie down, heart palpitations, I had significant weight gain, excessive swelling in my legs, belly, feet, ankles. I remember each day became unbearable and each night became a nightmare. At that point I knew something was wrong with my body.

In the years since the cardiomyopathy, she has needed two separate heart procedures: a defibrillator implanted in 2010, and open-heart surgery after a silent heart attack in 2012.

Anner: Do you look at your own life differently?

Jennifer:Listen Yes, I do. Seeing how something simple can — like childbirth — put so much stress on your body and seeing everything that you went through in terms of how you drastically had to change your diet, how you were going from no medication to five to six different medications, how your body reacted. Seeing how different stress in certain activities in life you couldn’t do in terms of like walking up the stairs, you couldn’t do. How little things like driving, you used to lose your breath and you used to have that plastic bag … not plastic … paper bag in your purse in case something happened, you had that, so yeah it has changed my life.

While the cause of PPCM remains unknown, Porter believes awareness among women and clinicians can save lives.

Anner:Listen I don’t want any other woman to experience a near-death pregnancy like I did, I feel that I must continue to bring awareness about this deadly disease that actually has no cure in sight.

Get Involved

These vignettes are snippets of hours-long conversations. The women talked with each other about their formative years, their painful memories of death or near death, and the advice they would give to expectant and new mothers. Often, what they heard from their loved ones surprised them.

If you’d like to facilitate your own conversation with your mother, daughter or granddaughter, we have written a list of questions. We encourage you to use them and record your own conversations.

Here’s how:

Download or print out this form with our suggested questions. But also feel free to make it your own.

Find a quiet space to record. We encourage you record this conversation using your phone or a digital recorder.

Feel free to share anything with us at maternal@propublica.org. Privacy note: nothing will be published without your permission.

ProPublica today named the seven newsrooms and local reporters that will participate in the inaugural ProPublica Local Reporting Network.

The yearlong initiative, which kicks off in January, was created to support investigative journalism at local and regional news organizations, particularly in cities with populations below 1 million. ProPublica will reimburse the newsrooms for salary for the selected reporters and provide extensive support and guidance for their stories.

Winners were selected from a pool of 239 applications from 45 states, plus Washington, D.C. and Puerto Rico. The projects selected by editors should surprise and probe deeply, with the potential to spur positive change. Topics covered, among others, will include conflicts of interest, housing, mental health care, criminal justice and workplace safety. The selected newsrooms and reporters are:

The Advocate (Baton Rouge, La.) — Rebekah Allen

Charleston Gazette-Mail (Charleston, W. Va.) — Ken Ward, Jr.

Malheur Enterprise (Vale, Ore.) — Jayme Fraser

Santa Fe New Mexican (Santa Fe, N.M.) — Rebecca Moss

South Bend Tribune (South Bend, Ind.) — Christian Sheckler

The Southern Illinoisan (Carbondale, Ill.) — Molly Parker

WMFE (Orlando, Fla.) — Abe Aboraya

Participants in the ProPublica Local Reporting Network will work in and report to their home newsrooms while collaborating with ProPublica senior editor Charles Ornstein. ProPublica's expertise with data, research and engagement will be available for their stories as well. The stories will be jointly published by their news organizations and ProPublica.

“This project was started to give local newsrooms across America needed resources and support to execute investigative journalism that digs deep and holds power to account,” Ornstein said. “The powerful proposals from our inaugural group of reporters are very much in that spirit, and I look forward to working with them to help bring their stories to fruition over the next year.”

For about 2 1/2 years now, I’ve been reporting on the Cook County property tax assessment system, uncovering inequities and explaining them to readers. At times, the work has been mind-numbing, with long stretches when I was lost in the weeds. But one thing was certain: Behind all the technical terms and the statistics was a story about the simple concept of fairness.

In many ways, the assessor’s office is a black box. Not even attorneys who have worked in the field for decades understand how the office derives values. And Cook County Assessor Joseph Berrios has refused to make that information public. My work, to some degree, involves poking holes in the box so we can shed light on how the office operates. My story this week on commercial and industrial assessments is the latest, following work I did on residential assessments for the Chicago Tribune.

In the early days of reporting these stories, I found Illinois Department of Revenue studies that suggested the property tax assessment system was deeply unfair. I wanted to determine if the evidence supported that assertion and proved the system was broken. As my reporting — and my work with colleague Sandhya Kambhampati — progressed and I learned more, I began to see how those with the least were paying more than they should while the wealthy paid less.

At a time when income inequality has grown to staggering proportions in our country, I came to see that the property tax system aggravated those disparities. Many of those who benefited were political heavyweights who also work as property tax lawyers.

How could I present this information in a way that would move readers and, perhaps, drive change? I knew the key was getting behind the numbers and finding the people who were harmed by the system. Their compelling stories fueled the narrative as we presented the nuts and bolts of this arcane system and our investigative findings about it.

I found people like Brenda Doyle, owner of Sweet Pea Academy day care, in the Auburn Gresham neighborhood on the South Side. She ran the day care with her husband, Larry, and daughter Jamilah. Sweet Pea is exactly the kind of small, family-owned business that should get a fair shake. Instead, its tax bill was far higher than it should have been, which made it hard for the family to stay afloat. The story about the Doyles’ business was similar to ones I discovered when reporting on residential assessments for the Chicago Tribune. For that project, I found a block in North Lawndale where nearly every property was overvalued. Many of the people I met grew up in their homes, having inherited them from their parents, and now are having trouble paying their property taxes because they were overvalued. People like Joan Clark, who struggled to pay the property tax bill on the home she grew up in because it was overvalued by 40 percent. She told me she was worried about losing her house.

These are the people who matter. They are why we worked so hard to shine a light on this issue.

There are two types of police reporters, Christian Sheckler recalls his executive editor telling him not too long ago: Those who try to make friends with officers and get rewarded with juicy tips about crimes, and those who press for answers on such thorny topics as civil rights, misconduct and accountability.

In his four years covering criminal justice at the South Bend Tribune, Sheckler said he’s chosen the second approach.

“That hasn’t gotten me invited to any barbecues,” he wrote in an application to be part of ProPublica’s new Local Reporting Network, “but I believe I’ve better served my readers with aggressive reporting on issues such as excessive force, the imperfect protective order system for domestic battery victims and policies on deadly high-speed police chases.”

Sheckler and the South Bend Tribune are among seven applicants we selected to be part of our inaugural local reporting project. With support from a new three-year grant, we’re covering the salary and benefits of a reporter at each of these news organizations. The reporters will spend next year working on an investigative project in their home newsrooms and they will receive extensive guidance and support from ProPublica. Their work will be co-published by their home newsroom and by ProPublica.

They were selected from a pool of 239 applications and will cover a diverse array of topics, including conflicts of interest, housing, workplace safety, mental health and criminal justice.

The other reporters and newsrooms chosen to take part in the reporting network include:

Rebekah Allen, a reporter at The Advocate, based in Baton Rouge, La. She is a member of the paper’s small team of reporters focused on investigative projects and enterprise stories. Last year, she produced a three-part series highlighting how the state’s powerful nursing home lobby fought off efforts to make it easier for the elderly and disabled to receive care in their homes. “As a result, nursing homes, ranked last in the nation in quality, have seen their budgets soar in a punishing financial climate where everyone from higher education to hospitals has seen dramatic reductions,” the paper said in introducing the series online.

Jayme Fraser, a reporter who will be working with the Malheur Enterprise, a weekly newspaper in Vale, Ore. Fraser has been an education and statewide projects reporter at the Missoulian in Missoula, Montana, and before that, at the Houston Chronicle. She has written about how the Indian Health Service isn’t meeting the needs of Native American patients, and about questionable science presented in a local “shaken baby” case. This fall, Fraser helped lead a first-time collaboration between the Missoulian and the University of Montana School of Journalism to investigate an issue at the intersection of health and criminal justice. The series will publish at the end of this month.

Molly Parker, an investigative reporter at The Southern Illinoisan, a newspaper in Carbondale, Ill. In the past two years, she has covered a public housing scandal in Cairo, Illinois, in which residents lived in deplorable conditions while managers of the housing authority received “hundreds of thousands of taxpayer dollars via questionable payments, bonuses, consultant contracts, retirement incentives and legal settlements in addition to their regular pay.” The crisis has drawn local and national attention.

Ken Ward Jr., a reporter at the Charleston Gazette-Mail since 1991 who covers the environment with a focus on coal mining, mine safety, the chemical industry and workplace safety. In 2014, when a chemical leak contaminated the drinking water of hundreds of thousands of people, Ward exposed significant flaws in federal safety guidelines for the chemicals and in the state’s water sampling program. His disclosures led to the appointment of an independent scientific team to examine the spill’s impacts. “I can’t think of many places that are in need of good journalism more than West Virginia is, or what higher calling journalists have than to try to write stories that make their home a better place,” Ward said in an interview with the Columbia Journalism Review a few years back.

One of our goals with this project is to not only reach communities ProPublica hasn’t previously covered, but to support journalism that emanates from those communities. Many of the reporters have long-established connections to the regions they’re now covering.

Parker, the reporter at The Southern Illinoisan, grew up and went to college in Southern Illinois. After graduating from college and graduate school, her journalism career took her to North Carolina, South Carolina and Mississippi. But home drew her back in 2014.

“What I quickly discovered through my reporting was that a lot had changed since I graduated from Vienna High School in 2000,” she wrote in her application to the Local Reporting Network, “Poverty has always plagued much of Southern Illinois, particularly the southernmost counties. But I don’t recall people being as hopeless as they are today.

“I don’t remember the poverty being as extreme and widespread, and indeed, data indicators show this is a growing problem and imminent crisis. I enjoy reporting in the region that raised me. Southern Illinois can serve up hefty servings of frustration, and the economic suffering I see breaks my heart. But there is an abundance of beauty here, of the natural and human variety. For me and many others, this will always be home.”

The midterm elections are less than a year away, and with the balance of power of both houses of Congress at stake, they seem likely to be closely fought. To help local journalists use election data to keep a close eye on candidates and races, we’re today announcing an update to our Election DataBot app.

A partnership with the Google News Lab, Election DataBot helps reporters, researchers and citizens keep track of campaign activity. The update adds a host of new information from ProPublica’s political data collection that will help users understand races in even more detail, and provide an even broader picture to their readers. DataBot users can sign up for email alerts for a particular candidate, committee or race, using a Google account.

Right now, DataBot’s most complete set of information is about congressional incumbents running for re-election. The press releases and news stories are about those lawmakers, while campaign videos and deleted tweets cover challengers and open seat candidates, too.

That means an even richer stream of data about high-profile contests such as the Nevada Senate race or the special Senate election in Alabama on Dec. 12. Election DataBot has a page for each race showing the most recent activity, meaning that reporters quickly can track super PACs spending money to support or oppose a candidate and delve more deeply into Roy Moore’s or Doug Jones’ pages or click on an item to see the FEC filing for each expenditure. Or you can search for a committee such as the Proven Conservative PAC, which backs Moore, and sign up for an alert each time Election DataBot gets updated information about its activities.

Election DataBot's Firehose feed for the Alabama Senate race

We’ve also beefed up campaign finance filings from Senate candidates, which are filed on paper, thanks to the Federal Election Commission’s API. We’ve also updated candidate information for 2018 Senate and House races, and will be adding Twitter and YouTube accounts for candidates as they appear. This far in advance, the field in many contests is still far from clear. The candidate filing deadline in many states is still months away. But with congressional candidates raising more than $386 million in the first six months of 2017, it is not too early to be keeping an eye on key races.

In the meantime, Election DataBot will get new information throughout each day, updating FEC filings every 15 minutes and other information several times a day. Because we have more information coming in, we’ve tightened up the main feed, called the Firehose, on the homepage, to cover activity from the past three days.

Existing users of the DataBot will notice that we’ve removed a few items, including election forecasts from FiveThirtyEight.com and recent polls. Because the Pollster API we used in the past only contains polls on presidential approval and generic House of Representatives election questions, race-specific polls no longer appear. We are looking for data sources that will let us return polling data to Election DataBot.

On a melancholy Saturday this past February, Shalon Irving’s “village” — the friends and family she had assembled to support her as a single mother — gathered at a funeral home in a prosperous black neighborhood in southwest Atlanta to say goodbye and send her home. The afternoon light was gray but bright, flooding through tall arched windows and pouring past white columns, illuminating the flag that covered her casket. Sprays of callas and roses dotted the room like giant corsages, flanking photos from happier times: Shalon in a slinky maternity dress, sprawled across her couch with her puppy; Shalon, sleepy-eyed and cradling the tiny head of her newborn daughter, Soleil. In one portrait Shalon wore a vibrant smile and the crisp uniform of the Commissioned Corps of the U.S. Public Health Service, where she had been a lieutenant commander. Many of the mourners were similarly attired. Shalon’s father, Samuel, surveyed the rows of somber faces from the lectern. “I’ve never been in a room with so many doctors,” he marveled. “… I’ve never seen so many Ph.D.s.”

At 36, Shalon had been part of their elite ranks — an epidemiologist at the Centers for Disease Control and Prevention, the preeminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick. “She wanted to expose how peoples’ limited health options were leading to poor health outcomes. To kind of uncover and undo the victim blaming that sometimes happens where it’s like, ‘Poor people don’t care about their health,’” said Rashid Njai, her mentor at the agency. Her Twitter bio declared: “I see inequity wherever it exists, call it by name, and work to eliminate it.”

Much of Shalon’s research had focused on how childhood experiences affect health over a lifetime. Her discovery in mid-2016 that she was pregnant with her first child had been unexpected and thrilling.

Then the unthinkable had happened. Three weeks after giving birth, Shalon had collapsed and died.

The sadness in the chapel was crushing. Shalon’s long-divorced parents had already buried both their sons; she had been their last remaining child. Wanda Irving had been especially close to her daughter —role model, traveling companion, emotional touchstone. She sat in the front row in a black suit and veiled hat, her face a portrait of unfathomable grief. Sometimes she held Soleil, fussing with her pink blanket. Sometimes Samuel held her, or one of Shalon’s friends.

A few of Shalon’s villagers rose to pay tribute; others sat quietly, poring through their funeral programs. Daniel Sellers, Shalon’s cousin from Ohio and the baby’s godfather, spoke for all of them when he promised Wanda that she would not have to raise her only grandchild alone. “People say to me, ‘She won’t know her mother.’ That’s not true,” Sellers said. “Her mother is in each and every one of you, each and every one of us. … This child is a gift to us. When you remember this child, you remember the love that God has pushed down through her for all of us. Soleil is our gift.”

Underneath the numb despair was a profound sense of failure — and an acute understanding of what Shalon’s death represented. The researcher working to eradicate disparities in health access and outcomes had become a symbol of one of the most troublesome health disparities facing black women in the U.S. today, disproportionately high rates of maternal mortality. The main federal agency seeking to understand why so many American women — especially black women — die and nearly die from complications of pregnancy and childbirth had lost one of its own. Even Shalon’s many advantages — her B.A. in sociology, her two master’s degrees and dual-subject Ph.D., her gold-plated insurance and rock-solid support system — had not been enough to ensure her survival. If a village this powerful hadn’t been able to protect her, was any black woman safe?

The memorial service drew to a close, the bugle strains of “Taps” as plaintive as a howl. Two members of the U.S. Honor Guard removed the flag from Shalon’s coffin and held it aloft. Then they folded it into a precise triangle small enough for Wanda and Samuel to hold next to their hearts.

Shalon MauRene Irving was a lieutenant commander in the uniformed ranks of the U.S. Public Health Service.
(Courtesy of Wanda Irving)

In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.

That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; from 2001 to 2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks.

The disproportionate toll on African Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, the World Health Organization estimates.

What’s more, even relatively well-off black women like Shalon Irving die or nearly die at higher rates than whites. Again, New York City offers a startling example: A 2016 analysis of five years of data found that black college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.

The fact that someone with Shalon’s social and economic advantages is at higher risk highlights how profound the inequities really are, said Raegan McDonald-Mosley, the chief medical officer for Planned Parenthood Federation of America, who met her in graduate school at Johns Hopkins University and was one of her closest friends. “It tells you that you can’t educate your way out of this problem. You can’t health-care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”

For much of American history, these types of disparities were largely blamed on blacks’ supposed innate susceptibility to illness — their “mass of imperfections,” as one doctor wrote in 1903 — and their own behavior. But now many social scientists and medical researchers agree, the problem isn’t race but racism.

The systemic problems start with the type of social inequities that Shalon studied — differential access to healthy food and clean drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation. Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes, and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.

Those problems are amplified by unconscious biases that are embedded throughout the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke.

Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn woman who took to bringing her white husband or in-laws to every prenatal visit.

Hakima Tafunzi Payne, a mother of nine in Kansas City, Missouri, who used to be a labor-and-delivery nurse and still attends births as a student midwife, has seen this cultural divide as both patient and caregiver. “The nursing culture is white, middle-class, and female, so is largely built around that identity. Anything that doesn’t fit that identity is suspect,” she said. Payne, who is also a nurse educator lecturing on unconscious bias for professional organizations, recalled “the conversations that took place behind the nurse’s station that just made assumptions — a lot of victim blaming, ‘If those people would only do blah, blah, blah, things would be different.’”

Black expectant and new mothers frequently told us that doctors and nurses didn’t take their pain seriously — a phenomenon borne out by numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer. When Patrisse Cullors, a cofounder of the Black Lives Matters movement who has become an activist to improve black maternal care, had an emergency C-section in Los Angeles in March 2016, the surgeon “never explained what he was doing to me,” she said. The pain medication didn’t work: “My mother basically had to scream at the doctors to give me the proper pain meds.” When white people advocate for themselves or their family members, she said, providers “think they’re acting reasonably. When black people are advocating for our family members, we’re complaining, we’re being uppity, we don’t know what we're talking about, we’re exaggerating.”

Limited diversity in the medical profession contributes to the black mothers’ sense of alienation. Blacks make up 6 percent of doctors (though 11 percent of OB-GYNs), 3 percent of medical school faculty and less than 2 percent of National Institutes of Health-funded principal investigators. “That's a real problem that across the spectrum that [black women] are not feeling listened to and respected—that’s a structural problem,” said Monica McLemore, a nursing professor at the University of California­, San Francisco, who has conducted focus groups with dozens of mothers as part of a $50 million initiative to reduce preterm births. “The health sector doesn’t want to admit how much of this is about us.”

But it’s the discrimination that black women experience in the rest of their lives — the double-whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes. An expanding field of research shows that the stress of being a black woman in American society can take a significant physical toll during pregnancy and childbirth.

Watch the Video

The U.S. medical system is still haunted by slavery.

“It’s chronic stress that just happens all the time — there is never a period where there’s rest from it, it’s everywhere, it’s in the air, it’s just affecting everything,” said Fleda Mask Jackson, an Atlanta researcher and member of the Black Mamas Matter Alliance who studies disparities in birth outcomes.

It’s a type of stress from which education and class provide no protection. “When you interview these doctors and lawyers and business executives, when you interview African-American college graduates, it’s not like their lives have been a walk in the park,” said Michael Lu, a longtime disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration, the main federal agency funding programs for mothers and infants. “It’s the experience of having to work harder than anybody else just to get equal pay and equal respect. It’s being followed around when you’re shopping at a nice store, or being stopped by the police when you’re driving in a nice neighborhood.”

Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” for how this continuous stress wears away at the body. Weathering “causes a lot of different health vulnerabilities and increases susceptibility to infection,” she said, “but also early onset of chronic diseases, in particular, hypertension and diabetes” — conditions that disproportionately affect blacks at much younger ages than whites. It accelerates aging at the cellular level; in a 2010 study, Geronimus and colleagues found that the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.

Weathering can have particularly serious repercussions in pregnancy and childbirth, the most physiologically complex time in a woman’s life. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday). Here again, income and education aren’t protective.

The effects on the mother’s health may also be far-reaching. Maternal age is an important risk factor for many severe pregnancy-related complications, as well as for chronic diseases that can affect pregnancy, like hypertension. “As women get older, birth outcomes get worse,” Lu said. “If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s.”

This means that for black women, the risks for pregnancy likely start at an earlier age than many clinicians — and women— realize, and the effects on their bodies may be much greater than for white women. This doesn’t mean that pregnancy should be thought of as inherently scary or dangerous for black women (or anyone). It does mean, in Geronimus’ view, that “a black woman of any social class, as early as her mid-20s, should be attended to differently” — with greater awareness of the potential challenges ahead.

That’s a paradigm shift that professional organizations and providers have barely begun to wrap their heads around. “There may be individual doctors or hospitals that are doing it [accounting for the higher risk of black women], but ... there’s not much of that going on,” Lu said. Should doctors and clinicians be taking into consideration this added layer of vulnerability?

“Yeah,” Lu said. “I truly think they should.”

Shalon, her baby brother Simone and her older brother Sam III, in a photo taken in the mid-1980s
(Courtesy of Wanda Irving)

Shalon Irving’s history is almost a textbook example of the kinds of strains and stresses that make high-achieving black women vulnerable. The child of two Dartmouth graduates, she grew up in Portland, Oregon, where her father’s father was pastor of a black church. Even in its current liberal incarnation, Portland is one of the whitest large cities in the U.S.

Thirty years ago, Portland was a much more uncomfortable place to be black. African-American life there was often characterized by social isolation, which Geronimus’ research suggests can be especially stressful. Samuel Irving spent years working as a railroad engineer; he got a law degree and later ran a city agency, but felt his prospects were still constrained by his race. Wanda held various jobs in marketing and communications, including at the U.S. Forest Service. In elementary school, Shalon was sometimes the only African-American kid in her class. “There were many mornings where she would stand outside banging on the door wanting to come back into the house because she didn’t want to go to school,” her mother recently recalled.

Shalon’s strategy for fitting in was to be smarter than everyone else. She read voraciously, wrote a column for a black-owned weekly newspaper and skipped a grade. Books and writing helped her cope with trauma and sorrow — first the death of her 20-month-old brother Simone in a car accident when she was six, then the fracturing of her parents’ marriage, then the diagnosis of her beloved older brother, Sam III, with a virulent form of early-onset multiple sclerosis when he was 17. Amid all the family troubles, Shalon was funny and driven, with a fierce sense of loyalty and “a moral compass that was amazing,” her mother said. She was also overweight and often anxious, given to daydreaming (as she later put it) about “alternative realities where people hadn’t died and things had not been lost.” When it came time to go away to college, she chose the historically black Hampton University in Virginia. “She wanted to feel that nurturing environment,” Wanda said. “She had had enough.”

By then, Shalon had noticed that many of her relatives — her mother’s mother, her aunts, her far-flung cousins — died in their 30s and 40s. Her brother, Sam III, sardonically joked that the family had a “death gene,” but Shalon didn’t think that was funny. “She didn’t understand why there was such a disparity with other families that had all these long lives,” Wanda said. Shalon nagged her father to stop smoking and her mother to lose weight. She set an example, shedding nearly 100 pounds while managing to graduate summa cum laude. At the start of graduate school at Purdue University, she was a svelte 138 pounds, “very classy and elegant, a lot like her mom,” said Bianca Pryor, a master’s student in consumer behavior who became one of what Shalon called her cherished circle of “sister friends.”

They were all bearing the same burden. “There’s this feeling that we’re carrying the expectations of generations, the first ones trying to climb the corporate ladder, trying to climb in academe,” said Pryor, now a marketing executive in New York City. “There is this idea that we have to work twice as hard as everyone else. But there’s also, ‘I’m first-generation, I don’t know the ropes, I don’t how to use my social capital.’ There’s a bit of shame in that … this constant checking in with yourself — am I doing this right?”

Shalon set the bar especially high: She was pursuing a double Ph.D. in sociology and gerontology, focusing on themes she would return to often — the long-term effects of early childhood trauma and maltreatment, the impact of the parent-child relationship on lifelong health. She finished in under five years, once again with top honors — “one of the best writers I’ve had in my academic career,” her adviser, sociologist Kenneth Ferraro, said.

Wanda and Shalon were so close, “they were like the ‘Gilmore Girls,’” one friend said.
(Courtesy of Wanda Irving)

She tried teaching, then decided to pursue a second master’s degree, this time from Johns Hopkins. She was also juggling family responsibilities. Wanda had followed Shalon around the country, earning her own master’s degree and working in nonprofit management. “They were like the ‘Gilmore Girls,’” Pryor said. In 2008, Sam III joined them in Baltimore to take part in a study on an experimental MS therapy. With his family’s support, he’d managed to finish college and run a poetry-slam nonprofit for kids. His next goal was to walk across the stage to receive his diploma instead of using his wheelchair. In February 2009, while he was doing physical rehab to regain strength in his legs, a blood clot traveled to his lung, killing him at the age of 32. Afterward, Wanda and Shalon clung to each other more tightly than ever.

In 2011 came what Ferraro called Shalon’s “change-the-world opportunity” — a consulting gig at the CDC with Michelle Obama’s “Let’s Move!” initiative. Soon she joined the agency’s prestigious Epidemic Intelligence Service, a training program in applied epidemiology — in her case, with a focus on community health — whose members served as first responders in health emergencies. As part of the uniformed ranks of the U.S. Public Health Service, she could eventually discharge her student debt — more than $165,000 for Hopkins alone — travel, buy a house. “The permanence was very appealing,” Pryor said.

What Shalon wasn’t prepared for was how unfulfilled she was. After Johns Hopkins, she had worked on the frontlines helping at-risk infants, teenage girls and mothers with HIV/AIDS. She was passionate about improving food and housing security to reduce people’s risk for high blood pressure and other cardiovascular problems, but felt like much of her CDC research ended up sitting on a shelf. It bothered her that she rarely met the people behind the data she was analyzing. “She might see the numbers, but I don’t think she actually saw that little girl or little boy have a healthier lunch,” Pryor said.

The stress and frustration triggered the old corrosive self-doubts. But gradually, Shalon saw a way out of the box. She joined the CDC’s Division of Violence Prevention, refocusing on issues around trauma and domestic abuse— a mission she saw as “liberating” for African-American women, Wanda said. She started a coaching business called Inclusivity Standard to advise young people from disadvantaged backgrounds who wanted to get into college or grad school, as well as organizations seeking to become more diverse. She enlisted her mother, now working as a consultant, and Pryor to join her team. And she decided to write a self-help book, on the theory that many people in the communities she cared about couldn’t afford psychotherapy or didn’t trust it. “She was one of those people — one thing is just not enough,” said her coauthor Habiba Tran, a therapist and life coach with a multicultural clientele. “One modality is just not enough. One way of [reaching people] is just not enough.”

“No words have been created to adequately capture the fear and love and excitement that I feel right now,” Shalon, shown here with her puppy Lady Day, wrote to her daughter.
(Courtesy of Wanda Irving)

Shalon couldn’t remember a time when she didn’t want to be a mother. But her romantic life had been a “20-year dating debacle,” she admitted in the manuscript of her self-help book, in part because “I am deathly scared of heartbreak and disappointment, and letting people in comes with the very real risk of both.”

In 2014, when Shalon was 34, medical problems forced the issue. For years she’d been suffering from uterine fibroids — non-malignant tumors that affect up to 80 percent of black women, leading to heavy menstrual bleeding, anemia and pelvic pain. No one knows what causes fibroids or why blacks are so susceptible. What is known is that the tumors can interfere with fertility — indeed, black women are nearly twice as likely to have infertility problems as whites, and when they undergo treatment, there’s much less likelihood that the treatments will succeed. Surgery bought her a little time, but her OB-GYN urged her not to delay getting pregnant much longer.

Shalon had spent her adult years defying stereotypes about black women; now she wrestled with the reality that by embracing single motherhood, she could become one. The financial risk was substantial — she’d just purchased a town house in the quiet Sandy Springs area north of Atlanta, and her CDC insurance only covered artificial insemination for wives using their husbands’ sperm. In Portland, no one would have blinked an eye at an unmarried professional woman having a child on her own, but in Atlanta, “there is very much a vibe there that things should happen in a certain order,” Pryor said. “And Shalon was not having that at all. She was like, ‘Nope, this is what it is.’”

The gamble — funded with her parents’ help — ended in a series of devastating failures. In September 2015, in the midst of one unsuccessful insemination treatment, Shalon was alarmed to discover that her right arm had become swollen and hard. Doctors found a blood clot and diagnosed her with Factor V Leiden, a genetic mutation that makes blood prone to abnormal clumping. Suddenly a part of the family’s medical mystery was solved. Wanda’s mother had died of a pulmonary embolism, so had Sam III, so had other members of their extended family. But no one had been tested for the mutation, which is primarily associated with European ancestry. Had they known they carried it, maybe Sam’s deadly blood clot could have been prevented. It was a what-if too painful to dwell on.

By April 2016, Shalon had given up. She had a new boyfriend and she was on her way to Puerto Rico to help with the CDC’S Zika response, working to prevent the spread of the virus to expectant mothers and their unborn babies. There she discovered she’d gotten pregnant by accident. Her excitement was tempered by fear that the baby might have contracted Zika, which can cause microcephaly and other birth defects. But a barrage of medical tests confirmed all was well.

More good news: A few weeks later Pryor learned she was pregnant, too. “All right,” she told Shalon, “let’s finally go after our rainbows and unicorns! Because for so long it was just dark clouds and rain.”

A worried Bianca Pryor quizzed her best friend from grad school: “Are you getting out of the house? Are you going for your walks?”
(Melissa Bunni Elian for ProPublica)

In reality, Shalon’s many risk factors — including her clotting disorder, her fibroid surgery, the 36 years of wear and tear on her telomeres, her weight — boded a challenging nine months. She also had a history of high blood pressure, though it was now under control without medication. “If I was the doctor taking care of her, I'd be like, ‘Oh, this is going to be a tough one,’” her OB-GYN friend Raegan McDonald-Mosley said.

Shalon got though the physical challenges surprisingly well. Her team at Emory University, one of the premier health systems in the South, had no trouble managing her clotting disorder with the blood thinner Lovenox. They worried that scarring from the fibroid surgery could result in a rupture if her uterus stretched too much, so they scheduled a C-section at 37 weeks. At several points, Shalon’s blood pressure did spike, Wanda said, but doctors ruled out preeclampsia (pregnancy-induced hypertension) and the numbers always fell back to normal.

Wanda blamed stress. There was the painful end to Shalon’s romance with her baby’s father and her dashed hopes of raising their child together. There were worries about money and panic attacks about the difficulties of being a black single mother in the South in the era of Trayvon Martin and Tamir Rice. Shalon told everyone she was hoping for a girl.

Steeped in research about how social support could buffer against stress and adversity, Shalon joined online groups for single moms and assembled a stalwart community she could quickly deploy for help. “She was all about the village,” Rashid Njai said. “She’d say, ‘I’m making sure that when I have my baby, the village is activated and ready to go.’”

She poured more of her anxious energy into finishing the first draft of the book. She sent Tran the manuscript on Jan. 2, the day before the planned C-section, then typed one last note to her child. Boy or girl, its nickname would be Sunny, in honor of her brother Sam, her “sunshine.”

“You will always be my most important accomplishment,” she wrote. “No words have been created to adequately capture the fear and love and excitement that I feel right now.”

Until recently, much of the discussion about maternal mortality has focused on pregnancy and childbirth. But according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For American women in general, postpartum care can be dangerously inadequate — often no more than a single appointment four to six weeks after going home. “If you’ve had a cesarean delivery, if you’ve had preeclampsia, if you’ve had gestational diabetes or diabetes, if you go home on an anticoagulant — all those women need to be seen significantly sooner than six weeks,” said Haywood Brown, a professor at Duke University medical school. Brown has made reforming postpartum care one of his main initiatives as president of the American Congress of Obstetricians and Gynecologists.

The dangers of sporadic postpartum care may be particularly great for black mothers. African Americans have higher rates of C-section and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They have disproportionate rates of preeclampsia and peripartum cardiomyopathy (a type of heart failure), two leading killers in the days and weeks after delivery. They’re twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment. If they experience discrimination or disrespect during pregnancy or childbirth, they may be more likely to skip postpartum visits to check on their own health (they do keep pediatrician appointments for their babies). Lack of paid maternity leave and childcare can create additional hurdles. In one study published earlier this year, two-thirds of low-income black women never made it to their doctor visit.

Meanwhile, many providers wrongly assume that the risks end when the baby is born — and that women who came through pregnancy and delivery without problems will stay healthy. In the case of black women, providers may not understand their true biological risks or evaluate those risks in a big-picture way. “The maternal experience isn’t over right at delivery. All of the due diligence that gets applied during the prenatal period needs to continue into the postpartum period,” said Eleni Tsigas, executive director of the Preeclampsia Foundation.

It’s not just doctors and nurses who need to think differently. Like a lot of expectant mothers, Shalon had an elaborate plan for how she wanted to give birth, even including what she wanted her surgical team to talk about (nothing political) and who would announce the baby’s gender (her mother, not a doctor or nurse). But like most pregnant women, she didn’t have a postpartum care plan for herself. “It was just trusting in the system that things were gonna go okay,” Wanda said. “And that if something came up, she’d be able to handle it.”

The birth was “a beautiful time,” Wanda said. Shalon did so well that she convinced her doctor to let her and Soleil — French for “sun” — leave the hospital after two nights (three or four nights are more typical). Then at home, “things got real,” Pryor said. “It was Shalon and her mom trying to figure things out, and the late nights, and trying to get baby on schedule. Shalon was very honest. She told me, ‘Friend, this is hard.’”

When Pryor found she was pregnant, too, with her son Everton, she told Shalon, “Let’s finally go after our rainbows and unicorns!”
(Melissa Bunni Elian for ProPublica)

C-sections have much higher complication rates than vaginal births. In Shalon’s case, the trouble — a painful lump on her incision — emerged a few days after she went home. The first doctor she saw, on Jan. 12, said it was nothing, but as she and her mother were leaving his office, they ran into her longtime OB-GYN, Elizabeth Collins. Collins took a look and diagnosed a hematoma — blood trapped in layers of healing skin, something that happens in about 1 percent of C-sections. The OB-GYN drained the “fluctuant mass” (as her notes described it), and “copious bloody non-purulent material” poured out from the one-inch incision. Collins also arranged for a visiting nurse to come by the house every other day to change the dressing. Collins didn’t respond to a request for comment.

Over the next two weeks, Shalon’s records show three more visits to Emory and two nursing visits at home. She feared that the incision wasn’t healing fast enough, perhaps because the blood thinners she was taking to prevent an embolism —another C-section risk — were hampering coagulation. But a wound specialist said everything looked OK. Shalon was worried about Soleil, too: Breastfeeding was harder than expected, and she’d stopped taking narcotic painkillers because she thought they were making the baby groggy. But less powerful painkillers weren’t working; between the pain and the anxiety, she was hardly sleeping. “Patient has poor endurance,” the visiting nurse noted on Jan. 16. “Leaving the home is a TAXING and CONSIDERABLE effort.”

What troubled the nurse most, though, was Shalon’s blood pressure. On Jan. 16 it was 158/100, high enough to raise concerns about postpartum preeclampsia, which can lead to seizures and stroke. But Shalon didn’t have other symptoms, such as headache or blurred vision. She made an appointment to see the OB-GYN for the next day, then ended up being too overwhelmed to go, the visiting nurse noted on Jan. 18. In that same record, the nurse wrote that Shalon had to change the dressing on her wound “sometimes several times a day due to large amounts of red drainage. This is adding to her stress as a new mom.” Her pain was 5 on a scale of 10, preventing her from “sleeping/relaxing.” Overall, Shalon told the nurse, “it just doesn’t feel right.” When the nurse measured her blood pressure on the cuff Shalon kept at home, the reading was 158/112. On the nurse’s equipment, the reading was 174/118.

“We provide caring and compassionate care to all of our patients,” the Visiting Nurse Health System said in an email. “She was in our care for less than four days but we gave the very best care we could.”

Under current ACOG guidelines, blood pressure readings that high should trigger more aggressive action, such as an immediate trip to the doctor for further evaluation, possibly medication and more careful monitoring. A history of hypertension and multiple other risks should raise more red flags, Tsigas said. “We need to look holistically at the risk factors irrespective of whether or not she had a diagnosis of preeclampsia,” she said. “If somebody has a whole plateful of risk factors, how are you treating them differently?” High blood pressure in the postpartum period should always be considered an emergency, she said.

“It would have made sense to admit her to the hospital for a complete work-up, including chest xray, an echocardiogram to evaluate for heart failure, and titration of her medication (both pain meds and hypertension meds) to sort out what she needed to feel OK and get [her] blood pressure out of the severe range,” wrote one doctor, a leading expert on postpartum care, who agreed to look at Shalon’s records at ProPublica’s request, but asked not to be identified. “Education on signs / symptoms of stroke seems insufficient — we don’t want to wait until someone is having a stroke to get their BP treated. A next-day follow-up for a BP of 174/118 seems questionable for a postpartum woman. Same-day assessment in her provider’s office, or in the ER, would have been very much within the bounds of common practice.”

Instead, Shalon was given an appointment for the following day, Jan. 19, with an OB-GYN at Women’s Center at Emory St. Joseph’s, which handled her primary care. By then, Shalon’s blood pressure had fallen, and there were “no symptoms concerning for postpartum [preeclampsia],” the doctor wrote in his notes. He wrote that Shalon was healing “appropriately” and thought her jumps in blood pressure were likely related to “poor pain control.” Wanda and Shalon left feeling more frustrated than ever.

At home over the next couple of days, Wanda noticed that one of Shalon’s legs was larger than the other. “She said, ‘Yeah, I know, Mom, and my knee hurts, I can’t bend it.”

When McDonald-Mosley looked over the voluminous medical records a few months later, what jumped out at her was the sense that Shalon’s caregivers didn’t seem to think of her as a patient who needed a heightened level of attention, despite the complexity of her pregnancy.

“She had all these risk factors. If you’re gonna pick someone who’s going to have a problem, it’s gonna be her. … She needs to be treated with caution.” The fact that her symptoms defied easy categorization was all the more reason to be vigilant, McDonald-Mosley said. “There were all these opportunities to identify that something was going wrong. To act on them sooner and they were missed. At multiple levels. At multiple parts of the health care system. They were missed.”

Shalon’s other friends were growing uneasy, too. Back in New York, Bianca Pryor had her own pregnancy emergency — her son was born very prematurely, at 24 weeks — so she couldn’t be in Atlanta. But she and Shalon talked often by phone. “She knew so much about her body one would think she was an M.D. and not a Ph.D. To hear her be concerned about her legs — that worried me.” Pryor encouraged her, “‘Friend, are you getting out of the house? Are you going for your walks? She told me, ‘No, I’m on my chaise lounge, and that’s about as much as I can do.’”

Habiba Tran was so upset at Shalon’s condition that she took her frustrations out on her friend. “I was cussing her out. ‘Go to the f— ing doctor.’ She’s like, ‘I called them. I talked to them. I went to see them. Get off my back.’”

Shalon took this selfie with her dad, Samuel, and her newborn daughter on the morning of Jan. 24, 2017. Twelve hours later, she collapsed.
(Courtesy of Wanda Irving)

On the morning of Tuesday, Jan. 24, Shalon took a selfie with her father, who’d been visiting for a week, then sent him to the airport to catch a flight back to Portland. Towards noon, she and Wanda and the baby drove to the Emory Women’s Center one more time. This time, Shalon saw a nurse practitioner. “We said, ‘Look, there's something wrong here, she’s not feeling well,’” Wanda recalled. “‘One leg is larger than the other, she’s still gaining weight’— nine pounds in 10 days — ‘the blood pressure is still up, there’s gotta be something wrong.”

The nurse’s records confirmed Shalon had swelling in both legs, with more swelling in the right one. She noted that Shalon had complained of “some mild headaches” and her blood pressure was back up to 163/99, but she didn’t have other preeclampsia signs, like blurred vision. She checked the incision — “warm dry no [sign/symptom] of infection” — and noted Shalon’s mental state (“cooperative, appropriate mood & affect, normal judgment”). She ordered an ultrasound to check the legs for blood clots, as well as preeclampsia screening.

Both tests came back negative. As Wanda remembers it, Shalon was insistent: “There is something wrong, I know my body. I don’t feel well, my legs are swollen, I’m gaining weight. I’m not voiding. I’m drinking a lot of water, but I’m retaining the water.” Before sending Shalon home, the nurse gave her a prescription for the blood pressure medication nifedipine, which is often used to treat pregnancy-related hypertension.

Emory Healthcare “is dedicated to the highest quality patient care,” it said in an email. It declined to answer questions about Shalon’s care, citing patient confidentiality.

Shalon and Wanda stopped at the pharmacy, then decided to go out to dinner with the baby. While they ate, they talked about a trip Shalon had planned for the three of them to take in just a few weeks. Ever since Sam III had died, Wanda and Shalon made a point of traveling someplace special on painful anniversaries. To mark his 40th birthday and the eighth anniversary of his death, Shalon had gotten the idea of going to Dubai. (“It’s cheap,” Shalon had told Wanda. “The money is worth so much more there. It’s supposed to be beautiful.”) She had long ago purchased their tickets and ordered the baby’s passport. Now Wanda was worried — would she be feeling well enough to make such a big trip with an infant? Shalon wasn’t willing to give up hope just yet. Wanda recalls her saying, “I’ll be fine, I’ll be fine.”

They got home and sat in Shalon’s bedroom for a while, laughing and playing with the baby. Around 8:30 p.m., Shalon suddenly declared, “I just don’t know, Mom, I just don’t feel well.” She took one of the blood pressure pills. An hour later, while she and Wanda were chatting, Shalon clutched her heart, gasped and passed out.

Paramedics arrived to find Shalon on the floor near the foot of her bed “pulseless and not breathing…” They tried to stabilize her, then rushed her to Atlanta’s Northside Hospital, just a couple of miles from her home. In the emergency room, doctors discovered that the breathing tube had been “incorrectly placed,” according to the ambulance service report — into her esophagus instead of her lungs. She never regained consciousness. Four days later, on Jan. 28, Wanda and Samuel withdrew life support and she died.

The news spread quickly among her colleagues at the CDC. William Callaghan, chief of the maternal and infant health branch, recalled in March that his boss, who had visited Shalon at the hospital, called to let him know. “It was a chilling phone call,” said Callaghan, one of the nation’s leading researchers on maternal mortality. “It certainly takes, in that moment, what I do, it made it very, very, very concrete. ... This was not about data, this was not about whether it was going up or it was going down. It was about this tragic event that happened to this woman, her family.”

Northside declined to do an autopsy, telling Wanda and Samuel that none was required, they recalled. (The hospital declined to comment.) So Wanda paid $4,500 for an autopsy by the medical examiners in neighboring DeKalb County. The report came back three months later. Noting that Shalon’s heart showed signs of damage consistent with hypertension, it attributed her death to complications of high blood pressure.

Wanda always knew she would be spending a lot of time caring for her granddaughter. She and Shalon loved the idea of the three of them making their way in the world together, trying to change it for the better.

The flag that covered Shalon’s casket is now in a memorial case with other mementos and photos
(Sheila Pree Bright for ProPublica)

Instead, Wanda has had to find a way to go on without her daughter and best friend. She took a break from her consultant work and moved into Shalon’s cozy townhouse, now crowded with baby books and gear, to assume her new role. Soleil was colicky, prone to gastric problems that kept both of them up all night. Shalon’s villagers stopped by often to help, but much of the time Wanda was on her own. Her grief was most acute at nights, but she couldn’t let it interfere with her duties to Soleil.

Eventually the colic went away and Soleil thrived. In June, Wanda and her five-month-old granddaughter went to Chattanooga for the annual meeting of U.S. Public Health Service scientists. A new honor — the Shalon Irving Memorial (Junior) Scientist Officer of the Year Award — had been created to celebrate Shalon’s legacy, and Wanda had been asked to say a few words. She handed the baby to one of Shalon’s CDC colleagues and took the small stage.

“Striving for excellence is a choice,” she told the audience through barely suppressed tears. “It is a commitment. … It’s a struggle to become the person you want to be. It’s harder than you want. It takes longer than you want. And it takes more out of you than you expected it should.”

Shalon personified excellence, Wanda said. “I don’t know if Shalon became the woman that she ultimately wanted to be. But I do know that she wanted to be the woman she was.”

She also knew how Shalon wanted to raise her daughter, and she was determined to do the same: reading to her, traveling with her, taking her to gymnastic and music classes. “She wanted Soleil to go to Montessori school, so I’m looking for a Montessori school for her,” Wanda said. “She wanted her to be christened, we got her christened.” Wanda and Soleil have developed a routine: Every morning they say hello to the photos of Shalon on the living room walls. Every evening they say goodnight. Sometimes Wanda shows Soleil the flag from her mother’s casket, now encased in a wooden frame. She set aside other mementos for later — the academic writings, the certificates and awards, the manuscript of her book with Tran. If all goes according to plan, it will be published early next year.

One Saturday afternoon in October, Wanda received another book, this one compiled by Shalon’s friends from the Epidemic Intelligence Service and entitled “Letters to Soleil.” She put the baby on her lap and said, “I’m gonna read you some letters about your mom.” One thing Wanda has tried never to do is cry in front of Soleil. But as she began reading aloud, she was sobbing. “And Soleil just kept looking at me — she couldn’t understand what was going on. And about a minute later she took my glasses off with her hands and put them down and then laid her head right on my chest and started patting me. Which made me cry all the more.”

Wanda in the living room of the town house she shares with Soleil. A photo of Shalon is in the background.
(Sheila Pree Bright for ProPublica)

Shalon was a letter-writer too. One day not long after the funeral, Wanda found a note that her daughter had written to her two years earlier, around the sixth anniversary of Sam III’s death. Shalon had left it among the other important items in her computer, trusting that if something ever happened to her, Wanda would find it. The letter reads like a premonition of her own death: Shalon wasn’t afraid for herself, but agonized over how it would affect her mother.

I am sorry that I have left you. On the particular day that I am writing this I have no idea how that may have occurred but know that I would never choose to leave.

I know it seems impossible right now, but please do not let this break you. I want you to be happy and smile. I want you to know that I am being watched after by my brothers and grandma and that we are all watching you. Please try not to cry. Use your energy instead to feel my love through time and space. Nothing can break the bond we have and you will forever be my mommy and I your baby girl!

Now 11 months old, Soleil has her mother’s precociousness, energy and headstrong yet sweet disposition. Like the sun she was named for, “she just lights up a room when she smiles,” Wanda said. She comes into Wanda’s bed every night and wakes her early to play. “She’ll bite my nose and kick me — ‘Nana, time to get up! Time to get up!’” And so Wanda does.